Authors (including presenting author) :
Kwok KM(1), Lee KL(1), Lam SY(1), Liong T(1), Wong HM(1), Lam PY(1), Chung WY(1), Tang SL(1), Hui CM(1), Shang ST(1), Lee P(2), Quan TW(2), Chan WY (2), Law KI(1)
Affiliation :
(1) Department of Intensive Care Unit, United Christian Hospital, (2) Dietetic Department, United Christian Hospital
Introduction :
Nutrition therapy is an integral element in the management of critically ill patients. Oral diet is often not feasible in these patients; enteral nutrition (EN) via nasogastric tube remains the most common form of nutrition support therapy in the Intensive Care Unit (ICU). Nutrition therapy can attenuate metabolic response to stress, prevent oxidative cellular injury, and favorably modulate immune responses. The provision of calories for energy substrate decreases muscle and tissue oxidation, increases protein synthesis, and maintains lean body mass. Caloric deficits have been associated with organ failure and increased hospital length of stay. Negative nitrogen balance has been associated with development of ICU-acquired weakness. Delivery of appropriate nutrition therapy is seen as a proactive therapeutic strategy that may reduce disease severity, diminish complications, decrease length of stay in ICU, and favorably impact patient outcomes.
Objectives :
To provide an universal nutritional risk assessment to ICU patients To facilitate early dietetic intervention for patients with high nutritional risk To enhance the provision of enteral nutrition using a standardized feeding protocol To create an electronic platform for monitoring of nutritional outcomes
Methodology :
The Critical Illness Enteral Nutrition Support Program was designed by a multidisciplinary working group consisting of critical care physicians, nurses and dietitians. The program consists of three main parts. A) Universal Nutritional Risk Assessment. All patients admitted to ICU undergo universal nutritional risk assessment using body mass index (BMI) and modified Nutrition Risk in Critically ill (NUTRIC) score. Patients with extremes of BMI or high modified NUTRIC score are considered as having high nutritional risk. These patients need early dietetic referral for intensive nutrition therapy. B) Enteral Nutrition Protocol. For patients with low nutritional risk, EN is initiated following ICU Enteral Nutrition Protocol. Calorie target is individualized according to patient’s weight. The standardized protocol provides instruction on feeding rate and strategies against feeding intolerance. C) Electronic Nutritional Monitoring System. Important nutritional data are stored in the electronic platform. With the collaboration with clinical informatics specialist, the platform was incorporated into the existing ICU clinical information system (CIS).
Result & Outcome :
The Critical Illness Enteral Nutrition Support Program has been implemented in ICU of United Christian Hospital since April, 2019. A post implementation survey has been conducted. In general, staff agreed that the program can effectively identify patients with high nutritional risk to facilitate early dietetic intervention. The enteral nutrition protocol enabled early EN initiation and avoid unnecessary interruption. The electronic platform interface was user-friendly for physicians and dietitians to closely monitor patient’s nutritional status. The Program has also eliminated the use of gastric residual volume (GRV) without increase in feeding intolerance.
