title: Nutrition therapy for the critically ill surgical patient: we need to do better!
abstract: BACKGROUND
  To identify opportunities for quality improvement, the nutrition adequacy of critically ill surgical patients, in contrast to medical patients, is described.
  
  
  METHODS
  International, prospective, and observational studies conducted in 2007 and 2008 in 269 intensive care units (ICUs) were combined for purposes of this analysis. Sites provided institutional and patient characteristics and nutrition data from ICU admission to ICU discharge for maximum of 12 days. Medical and surgical patients staying in ICU at least 3 days were compared.
  
  
  RESULTS
  A total of 5497 mechanically ventilated adult patients were enrolled; 37.7% had surgical ICU admission diagnosis. Surgical patients were less likely to receive enteral nutrition (EN) (54.6% vs 77.8%) and more likely to receive parenteral nutrition (PN) (13.9% vs 4.4%) (P < .0001). Among patients initiating EN in ICU, surgical patients started EN 21.0 hours later on average (57.8 vs 36.8 hours, P < .0001). Consequently, surgical patients received less of their prescribed calories from EN (33.4% vs 49.6%, P < .0001) or from all nutrition sources (45.8% vs 56.1%, P < .0001). These differences remained after adjustment for patient and site characteristics. Patients undergoing cardiovascular and gastrointestinal surgery were more likely to use PN, were less likely to use EN, started EN later, and had lower total nutrition and EN adequacy rates compared with other surgical patients. Use of feeding and/or glycemic control protocols was associated with increased nutrition adequacy.
  
  
  CONCLUSIONS
  Surgical patients receive less nutrition than medical patients. Cardiovascular and gastrointestinal surgery patients are at highest risk of iatrogenic malnutrition. Strategies to improve nutrition performance, including use of protocols, are needed.
authors.affiliation: Department of Surgery, Queen'sUniversity, Kingston, Ontario, Canada.
authors.forename: John W
authors.initials: JW
authors.lastname: Drover
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Cahill
authors.forename: Jim
authors.initials: J
authors.lastname: Kutsogiannis
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Pagliarello
authors.forename: Paul
authors.initials: P
authors.lastname: Wischmeyer
authors.forename: Miao
authors.initials: M
authors.lastname: Wang
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D016638:Critical Illness / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D044623:Nutrition Therapy / Q000592:standards* / Q000706:statistics & numerical data; D009752:Nutritional Status; D019990:Perioperative Care / Q000592:standards* / Q000706:statistics & numerical data; D058996:Quality Improvement; D012121:Respiration, Artificial