Original articleEducation program on medical nutrition and length of stay of critically ill patients☆
Introduction
In critically ill patients, nutritional therapy (NT) is an important component of care and seems to positively impact clinical outcomes.1, 2, 3 Patients with severe illness who do not receive adequate nutritional support are prone to complications, such as prolonged mechanical ventilation, increased ICU length of stay (ICU LOS), and higher mortality rates.4, 5, 6 Nutritional support for critically ill patients is aimed at correcting nutritional deficiencies, improving immune responses, reducing oxidative stress, preserving the function and structure of the gastrointestinal tract, and modulating the inflammatory response.4, 7 Although some international guidelines based largely on scientific evidence have established recommendations for NT in the ICU setting,4, 6, 7 some mismatches remain between these recommendations and clinical practice,8 and the number of critically ill patients who receive any type of NT can vary from 14% to 67% worldwide.4
There are several potential reasons for the failure to provide all patients with adequate nutritional therapy. Even if doctors believe that it is important,9, 10 they lack the knowledge to prescribe appropriate nutritional interventions. Also, clinical nutrition is not adequately emphasized during medical school training.11 We hypothesized that an educational intervention in the ICU could improve the clinical and nutritional parameters of critically ill patients. The present study prospectively evaluated the influence of a multifaceted nutritional educational intervention for nutritional support in an ICU. The proposed program consists of several elements, including teaching appropriate nutritional interventions, didactic educational programs, and bedside clinical discussions.
Section snippets
Trial design and participants
We conducted a prospective, non-blinded study with a non-contemporaneous control group at a 16-bed intensive care unit (ICU) at the Hospital das Clinicas – Department of Gastroenterology, University of Sao Paulo Medical School in Sao Paulo, Brazil. The local ethics committee approved the research plan and each patient or responsible relative provided signed informed consent before beginning the investigational activities. The study was conducted in three phases from December 2009 to December
Results
Physicians who underwent the education program on medical nutrition scored higher on the post-EP evaluation than the pre-EP one. The mean (standard deviation) number of correct answers was 4.8 ± 1.2 on the pre-EP evaluation vs. 7.9 ± 1.2 on the post-EP evaluation (mean ± SD, p < 0.001).
When comparing the overall characteristics of patients evaluated before and after the NT education program, no significant differences were found in terms of age, gender, SGA score, APACHE II score, diagnosis at
Discussion
The main finding of our study was that an education program in NT for intensive care physicians had a positive impact, improving the quality of NT and reducing the length of stay in the ICU.
Although we had 2 cohorts comprising 50 non-randomized patients each, the groups of patients evaluated in the pre-educational (Pre-EP) and post-educational (Post-EP) programs were comparable, except for body mass index (BMI), which was significantly higher in the Pre-EP than the Post-EP group. However, all
Statement of authorship
M.G.C. and D.W. have made substantial contributions to conception and design, analysis and interpretation of data; C.E.P and C.V. made substantial contributions for acquisition of data and analysis. L.M.H, C.E.P. and M.G.C. have been involved in drafting the manuscript and revising it critically for important intellectual content; D.W. have given final approval of the version to be published. None of the authors have any conflict of interest.
Conflict of interest
None declared.
Acknowledgments
Part of this paper was presented orally at the 33rd ESPEN Congress of Clinical Nutrition and Metabolism (2011), Gothenburg, 3 September to Tuesday 6 September 2011 and Melina Gouveia Castro was awarded a travel grant.
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Conference presentation: Part of this paper was presented orally at the 33rd ESPEN Congress of Clinical Nutrition and Metabolism (2011), Gothenburg, 3 September to Tuesday 6 September 2011.