Analysis of the nutritional management practices in intensive care: Identification of needs for improvement

• Published in: Medicina intensiva (English ed.) 2015-12, Vol.39 (9), p.530-536
• Main Authors: Lázaro-Martín, N.I, Catalán-González, M, García-Fuentes, C, Terceros-Almanza, L, Montejo-González, J.C
• Format: Article
• Language: English
• Subjects: Critical Care; Internal Medicine
• ISSN: 2173-5727; 2173-5727
• DOI: 10.1016/j.medine.2015.04.002

Abstract Objectives 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. Design Prospective observational study in 3 phases: (1) observation; (2) analysis, proposal development and dissemination; (3) analysis of the implementation. Setting ICU of a hospital of high complexity. Participants Adult ICU forecast more than 48 h of artificial nutrition. Primary endpoints 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.