title: Improving the Practice of Nutrition Therapy in the NRITLD Critically Ill Patients: An International Quality Improvement Project.
abstract: BACKGROUND
  In previous decades several studies have been performed demonstrating that providing appropriate nutritional support to intensive care unit patients affects complications, time of mechanical ventilation, length of ICU stay, and risk of death. In this study we provided a report of nutrition statuses in Masih Daneshvari's ICU as compared to 156 ICUs from 20 countries that participated in an international nutrition survey.
  
  
  METHODS
  All patients admitted to an intensive care unit during a specified one-month period who required artificial nutrition were included in this study. Characteristics of patients, performance of nutrition practices, and ICU outcomes were registered for all patients and compared with data from 156 other intensive care units from various countries around the world.
  
  
  RESULTS
  Twenty patients, of which 11(55%) were males and 9(45%) were females, were included in this study. The median age was 50.5 yrs (IQR: 40.5-56.0). Seventeen (85%) of them had EN nutrition only, 2(10%) had PN nutrition only, and 1(5%) had both EN and PN nutrition during their stay in the ICU. The adequacy of calorie intake was 67.6% (vs. 61.1% in all 157 ICUs) and the adequacy of protein intake was 84.9% (vs. 56.7% in 157 ICUs).
  
  
  CONCLUSIONS
  In our ICU, enteral feeding was superior to parenteral feeding. Also we considered early initiation of enteral feeding within 48 hours following ICU admission. We just used polymeric formula during this study. As a result of formula variation limits, we overestimated calories and protein needs. Glutamine and Selenium supplementations have not been used yet for patient in our ICU, regardless of their proven benefits in oxidative stress conditions like pulmonary diseases. Therefore, limited use of supplementations like selenium is inevitably among the disadvantages of Masih Daneshvari Hospital's ICU, which is a tertiary-care center for chronic pulmonary diseases.
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Seyed Mohammadreza
authors.initials: SM
authors.lastname: Hashemian
authors.affiliation: Critical Care Nutrition Team in Ontario, Canada.
authors.forename: Naomi
authors.initials: N
authors.lastname: Cahill
authors.affiliation: Critical Care Nutrition Team in Ontario, Canada.
authors.forename: Lauren
authors.initials: L
authors.lastname: Murch
authors.affiliation: Critical Care Nutrition Team in Ontario, Canada.
authors.forename: Miao
authors.initials: M
authors.lastname: Wang
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Jamaati
authors.affiliation: Lung Transplantation Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran-Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Malekmohammad
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Behrooz
authors.initials: B
authors.lastname: Farzanegan
authors.affiliation: Mycobacteriology Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran-Iran.
authors.forename: Payam
authors.initials: P
authors.lastname: Tabarsi
authors.affiliation: Clinical Tuberculosis and Epidemiologic Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran-Iran.
authors.forename: Majid
authors.initials: M
authors.lastname: Marjani
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Makan
authors.initials: M
authors.lastname: Sadr
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Fanak
authors.initials: F
authors.lastname: Fahimi
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Bagheri
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Farzin
authors.initials: F
authors.lastname: Ghiasi
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Poopak
authors.initials: P
authors.lastname: Asadi
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Behzad
authors.initials: B
authors.lastname: Hatami
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Mandana
authors.initials: M
authors.lastname: Chitsazan
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Arvin
authors.initials: A
authors.lastname: Najafi
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Mahdieh
authors.initials: M
authors.lastname: Jamshidi
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Kowsar
authors.initials: K
authors.lastname: Hedayat
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Golnar
authors.initials: G
authors.lastname: Radmand
authors.affiliation: Department of General Surgery, Academic Medical Center, Cologne, Germany.
authors.forename: Amir
authors.initials: A
authors.lastname: Bayanzadeh
authors.affiliation: Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Canada.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Masjedi
authors.affiliation: Department of Medicine and Epidemiology at Queen's University, Director of Research for the Critical Care Program and the Director of the Clinical Evaluation Research Unit at the Kingston General Hospital, Kingston, Canada.
authors.forename: Daren
authors.initials: D
authors.lastname: Heyland
keywords: Critical care; Intensive care unit; Nutrition; Quality improvement