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Nutrition support in ICU – impact of a specialist service provision

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on 2 August 2015

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Transcript of Nutrition support in ICU – impact of a specialist service provision

Bedour Handoom
Nutrition support in ICU
impact of
a specialist service provision
Intensive
Care
Unit
(ICU)
Existing Guidelines
Adherence to the recommendation !!
The Research Project:
Zoom in for details
A
I
M
C
I
U
Supervised By:
Dr Helen McCarthy
Mrs Pauline Douglas
MSc student, Human Nutrition
What are we talking about?
Out Lines:
Background rational
Intensive care unit
Nutrition therapy / Adherence to the recommendation
Guidelines
Research challenges / Controversial highlights
The Research Project
Aim
Design
Population
Data collection
Statistical analysis
Specially staffed and equipped
Separate and self-contained
Patients with life-threatening
Multiple-organ failure
High dependency
Staff to patient ratio

{{1. Danbury, C. 2013;}}
Nutrition therapy in the intensive care setting
little is known about nutritional practices in European intensive care units
whether they match existing guidelines
some variations in enteral nutrition practices
do not conform to international guidelines for enteral feeding
{{2. P,Fulbrook 2007;}}
The European Society for Clinical Nutrition and Metabolism (ESPEN) Guidelines on Enteral Nutrition: Intensive care, 2006
{{6. Kreymann,K.G. 2006}}

Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient:: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), 2009
{{7. McClave,S.A. 2009}}

The Canadian Critical Care Nutrition Guidelines in 2013: An Update on Current Recommendations and Implementation Strategies
{{8. Dhaliwal,R. 2013}}
The Use of Enteral Nutrition vs. Parenteral Nutrition

Early vs. Delayed Nutrient Intake

Composition of Enteral Nutrition:
High Protein vs. Low Protein
Whole Protein vs. Peptides

Immune enhancing diets: Glutamine use
Controversial highlights
Not Homogeneous!
Heterogeneity vs. Homogeneity
Very Heterogeneous..
The aim of my study is to prove that dedicating a specialist dietician on nutrition support provision within adult intensive care unit improve the outcomes of these population

Study Population:
Adult patients (18 years and older) both gender, who were to receive nothing by mouth, were placed on enteral tube feeding and have length of stay for 5 or more days in Intensive Care Unit.
Design
Combined retrospective and prospective observational study have been done with conjunction of Southern Health & Social Care Trust
Data Collection
A specialist ICU dietician prospectively gathered nutrition related information (under the population criteria) which was collected over 6 month period
Plus, retrospective information will be obtained from medical reports of (matched population criteria) prior to the introduction of special dietetic services, will be gathered over 6 month period
And we will try to match different aspects as we can such as:
Generic demographic
Nutritional information
Medical Status
as documented.
Statistical Analysis:
Data will be coded and entered into the SPSS programme.
Descriptive statistics such as frequency, means and standard deviation will be generated for normality
Comparative analysis of the retrospective and prospective groups will be undertaken using Chi-squared and independent sample t-test
(or non-parametric alternatives).
To identify factors contributing to successful clinical and nutritional outcomes
regression and factor analysis will be used.

There is variable performance with respect to intensive care nutrition practices across the world.
Adherence to some recommendations was high, but large gaps exist between many recommendations and actual practice in intensive care units.
Expected Outcomes..
There must be a dietician as part of the intensive care multidisciplinary team
{{1. Danbury, C. 2013;}}
{{3. Heyland. D.K 2010}}
{{4. Cahill, N.E. 2010}}
Small improvements in nutrition practice, but no significant effect on patient outcomes.
{{5. Cahill,N.E. 2010;}}
{{7. McClave,S.A. 2009;}}
{{6. Kreymann,K.G. 2006;}}
{{9. Prin,M. 2012}}
{{10. S,Ridley}}
Primary outcomes..
Having a specialist dietician in ICU is improving the nutritional management of critically ill patients.

Secondary outcomes..
To report on factors contributing in improving all nutritional and medical outcomes of ICU patients.

Timeline
Thank you for listening
Full transcript