title: The impact of implementation of a nutrition support algorithm on nutrition care outcomes in an intensive care unit.
abstract: BACKGROUND
  A nutrition support algorithm is an operational version of a guideline that is adapted to local requirements and easy to apply in clinical practice. The purpose of this study was to determine the impact of implementing a nutrition support algorithm on nutrition care outcomes in an intensive care unit (ICU) in Switzerland without a designated dietitian.
  
  
  METHODS
  The retrospective study included data collection on 2 cohorts of critically ill patients before (n = 56) and after (n = 56) implementation of a nutrition support algorithm based on the guidelines published by the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition guidelines.
  
  
  RESULTS
  There were significant differences between groups for the mean delivery of total energy in the pre- vs postimplementation group (909 ± 444 vs 1097 ± 420 kcal/d; P = .023) and mean delivery of protein per day (35 ± 17.9 vs 59.1 ± 27.3 g; P < .001). For patients staying at least 7 days in the ICU, the cumulative energy deficit decreased from -5664 ± 3613 kcal in the preimplementation group to -2972 ± 2420 kcal (P = .011) in the postimplementation group. No significant differences in the route of feeding and timing of enteral nutrition initiation were found.
  
  
  CONCLUSIONS
  Implementation of a nutrition support algorithm resulted in improved provision of energy and protein delivery. This may be further improved with routine nutrition assessment by a dietitian or a designated nutrition support team.
authors.affiliation: University Hospital Basel, Ernährungsberatung, Basel, 4031, Switzerland. clinical.nutrition@bluewin.ch
authors.forename: Caroline M
authors.initials: CM
authors.lastname: Kiss
authors.forename: Laura
authors.initials: L
authors.lastname: Byham-Gray
authors.forename: Robert
authors.initials: R
authors.lastname: Denmark
authors.forename: Rene
authors.initials: R
authors.lastname: Loetscher
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Brody
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000592:standards*; D008297:Male; D044342:Malnutrition / Q000503:physiopathology / Q000517:prevention & control; D008875:Middle Aged; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000379:methods* / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins