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Improving energy and protein intake via an oral nutrition support pathway in the intensive care unit and beyond: An
Alicia N Wiese1, Emma Ballard2
1Department of Nutrition and Foodservices, Redcliffe Hospital, Redcliffe, QLD, Australia.
Background:
Survivors of critical illness face multiple barriers to adequate oral intake. Research suggests these patients are not meeting nutrition requirements, yet no guidelines or published studies exist to improve energy and protein intake post critical illness.
Objectives:
The aim of our study was to increase energy and protein intake of patients in the intensive care unit (ICU) and beyond onto the post-ICU ward via the implementation of a multidisciplinary, individualised oral nutrition support pathway.
Methods:
We conducted a prospective single-centre, uncontrolled before-and-after study in a 10-bed ICU comprising 112 patients. Consecutively admitted patients expected to remain in the ICU for ≥48 h were followed up from commencement of oral intake for 15 days. Pre-implementation, patients received standard care, while post-implementation, patients followed the oral nutrition support pathway. This included energy- and protein-dense foods, oral nutrition supplements, and nutrition screening. Adequacy of energy and protein intake was expressed as the percentage of estimated energy requirements (EERs) and percentage of estimated protein requirements (EPRs) met, and the proportion of patients meeting ≥80% of their EERs and EPRs on average were compared pre-implementation and post-implementation.
Results:
Post-implementation, there was a significant increase in the percentage of EERs and EPRs met with a mean difference between periods of 34% (95% confidence interval: 22-46) for energy and 28% (95% confidence interval: 16-40) for protein. The proportion of patients meeting ≥80% of EERs significantly increased post-implementation (pre: 19.6% vs post: 58.9%, p < 0.001) as did those meeting ≥80% of EPRs (pre: 12.5% vs post: 46.4%, p < 0.001).
Conclusions:
A multidisciplinary, individualised oral nutrition support pathway significantly improved energy and protein delivery of critically ill and post-critically ill patients for 15 days from the initiation of oral intake. Further work is required to ascertain the impact of this on clinical outcomes.
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