title: Analysis of the nutritional management practices in intensive care: Identification of needs for improvement.
abstract: OBJECTIVE
  To analyze the nutritional management practices in Intensive Care (ICU) to detect the need for improvement actions. Re-evaluate the process after implementation of improvement actions.
  
  
  METHODS
  Prospective observational study in 3 phases: 1) observation; 2) analysis, proposal development and dissemination; 3) analysis of the implementation.
  
  
  METHODS
  ICU of a hospital of high complexity.
  
  
  METHODS
  Adult ICU forecast more than 48h of artificial nutrition.
  
  
  METHODS
  Parenteral nutrition (PN), enteral nutrition (EN) (type, average effective volume, complications) and average nutritional ratio.
  
  
  RESULTS
  A total of 229 patients (phase 1: 110, phase 3: 119). After analyzing the initial results, were proposed: increased use and precocity of EN, increased protein intake, nutritional monitoring effectiveness and increased supplementary indication NP. The measures were broadcast at specific meetings. During phase 3 more patients received EN (55.5 vs. 78.2%, P=.001), with no significant difference in the start time (1.66 vs. 2.33 days), duration (6.82 vs. 10,12 days) or complications (37,7 vs. 47,3%).Use of hyperproteic diets was higher in phase 3 (0 vs. 13.01%, P<.05). The use of NP was similar (48.2 vs. 48,7%) with a tendency to a later onset in phase 3 (1.25±1.25 vs. 2.45±3.22 days). There were no significant differences in the average nutritional ratio (0.56±0.28 vs. 0.61±0.27, P=.56).
  
  
  CONCLUSIONS
  The use of EN and the protein intake increased, without appreciating effects on other improvement measures. Other methods appear to be necessary for the proper implementation of improvement measures.
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España. Electronic address: lazaronoelia@hotmail.com.
authors.forename: N I
authors.initials: NI
authors.lastname: Lázaro-Martín
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: M
authors.initials: M
authors.lastname: Catalán-González
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: C
authors.initials: C
authors.lastname: García-Fuentes
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: L
authors.initials: L
authors.lastname: Terceros-Almanza
authors.affiliation: Servicio de Medicina Intensiva, Hospital Universitario 12 de Octubre, Madrid, España.
authors.forename: J C
authors.initials: JC
authors.lastname: Montejo-González
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage; D019587:Dietary Supplements; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D019983:Guideline Adherence; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D008875:Middle Aged; D018673:Nutrition Policy; D018529:Nutritional Support; D010288:Parenteral Nutrition / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D058996:Quality Improvement; D062606:Tertiary Care Centers; D014193:Trauma Centers / Q000458:organization & administration*
chemical_list: D004044:Dietary Proteins
keywords: Critically ill patient; Enteral nutrition; Indicadores de calidad; Nutrición enteral; Nutrición parenteral; Paciente crítico; Parenteral nutrition; Quality indicators