Nutrition Support in the Critically Ill: A Physician Survey

Abstract

This study demonstrates a substantial discordance in physician perceptions and practice patterns regarding initiation and management of nutrition in ICU patients, indicating an urgent need for nutrition-related education at all levels of training.

Nutrition in the intensive care unit

“…Preliminary studies are positive and show increased short-and long-term compliance with the guidelines after minimal, but consistent, training programs. 8,10,11 educAtIonAl competence of heAlthcAre professIonAls Physicians at Rush University Medical Center were surveyed to ascertain their understanding and application of NT. 8 All groups, attending physicians, fellows, and residents, agreed and placed high value (4.5 out of 5 point scale) on the significance of nutrition in the outcomes of critically ill patients.…”

“…8,10,11 educAtIonAl competence of heAlthcAre professIonAls Physicians at Rush University Medical Center were surveyed to ascertain their understanding and application of NT. 8 All groups, attending physicians, fellows, and residents, agreed and placed high value (4.5 out of 5 point scale) on the significance of nutrition in the outcomes of critically ill patients. Next they were questioned on their comfort level with the NT offered at their institution.…”

“…[8][9][10][11][12] The results indicate that delayed initiation of EN, determination of total caloric need, utility of residual volumes, interruptions of tube feeding, and prolonged fasting periods were the is- Table 1 sues with highest discordance rates. We will briefly address each of these.…”

“…[3][4][5][6][7] These guidelines are needed since nearly 40% of patients admitted to the hospital are malnourished at admission and over 2/3 of hospitalized patients experience deteriorating nutritional status while under "proper" hospital care. 8,9 Despite increased awareness of the importance of nutrition for recovery from critical illness, there remains a large gap between recommendations and application. Studies in the United States report that the percentage of critically ill patients attaining NT goals within the first 72 hours varies from 30% to 85%.…”

“…Most medical train-ing programs in the US have limited exposure to nutrition education, and studies have shown a notable discordance between nutrition knowledge and application among physicians, fellows, and residents. 8,[10][11][12][13] This disunity in nutrition management in medical professionals is worrisome and identifies an opportunity to improve outcomes through education.…”