Nutrition support in the critically ill: a physician survey.
BACKGROUND
Current clinical practice guidelines delineate optimal nutrition management in the intensive care unit (ICU) patient. In light of these existing data, the authors identify current physician perceptions of nutrition in critical illness, preferences relating to initiation of feeding, and management practices specific to nutrition after initiation of feeding in the ICU patient.


METHODS
The authors electronically distributed a 12-question survey to attending physicians, fellows, and residents who routinely admit patients to medical and surgical ICUs.


RESULTS
On a scale ranging from 1 to 5 (1 = low, 5 = high), the attending physician's mean rating for importance of nutrition in the ICU was 4.60, the rating for comfort level with the nutrition support at the authors' institution was 3.70, and the rating for the physician's own understanding of nutrition support in critically ill patients was 3.33. Attending physicians, fellows, and residents reported waiting an average of 2.43, 1.79, and 2.63 days, respectively, before addressing nutrition status in an ICU patient. Fifty-two percent of attending physicians chose parenteral nutrition as the preferred route of nutrition support in a patient with necrotizing pancreatitis. If a patient experiences enteral feeding intolerance, physicians most commonly would stop tube feeds. There was no significant difference in responses to any of the survey questions between attending physicians, fellows, and residents.


CONCLUSIONS
This study demonstrates a substantial discordance in physician perceptions and practice patterns regarding initiation and management of nutrition in ICU patients, indicating an urgent need for nutrition-related education at all levels of training.
Behara
Ami Shah
AS
Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA.
Peterson
Sarah J
SJ
Chen
Yimin
Y
Butsch
John
J
Lateef
Omar
O
Komanduri
Srinadh
S
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D016009:Chi-Square Distribution; D002983:Clinical Competence; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D007396:Internship and Residency; D008505:Medical Staff, Hospital; D052756:Nutritional Sciences / Q000193:education*; D018529:Nutritional Support / Q000379:methods; D010820:Physicians / Q000523:psychology*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011795:Surveys and Questionnaires