Infuse Infuse 10 December 2019 | Page 31

Nutrition in critical care is in the spotlight at the moment. Several large randomised controlled trials have been completed recently all with one big problem -the nutrition interventions were 5-7 days. 66%] energy and 48% [13-63%] protein) 1 . Moreover, patients got closest to their energy and protein needs when they received oral nutrition combined with gastric feeding 1 . Most of the trials have shown no differences or only small differences with questionable clinical importance between study arms. Why might this be? One explanation may be that nutrition is not important in critical care. However, that’s probably not the case. A more likely explanation is that we don’t' fully understand when nutrition is important is most important in critical illness. Patients recovering from critical illness experience complex and multifactorial issues around appetite and taste, the way they feel about their body and eating, and physical weakness 2, 3 . Furthermore, hospital and food service system practices such as removal of gastric tubes prior to oral intake impact a patient’s ability to eat but has never been addressed in any large studies to date 2-4 . I have over 14 years experience as an academic clinical dietitian and I’ve always found it strange that we try so hard in the ICU, only to send our patients to the ward where they stay longer and receive less nourishment. Recently, we investigated this by following 32 patients from ICU to hospital discharge at two hospitals and assessed nutrition intake three times a week. To understand more about the impact of nutrition and the issues patients face in the later stages of critical illness, our team is currently running a pilot, randomised, feasibility trial with 14 hospitals around Australia and New Zealand. With a sample size of 240 patients, this trial will generate knowledge that has not existed before. In the meantime, I encourage dietitians to advocate for patients in the ICU. Help the treatment team understand the impact of gastric tube removal and reinforce the importance of continuing nutrition care as patients transition to the ward. A little extra effort can have a meaningful impact on the recovery process. The majority of patients received oral nutrition alone (55% of study days) and nutrition intake varied according to how much nutrition support they received. Energy and protein provision as a proportion of estimated requirements was the lowest in patients who received oral intake with no oral nutrition supplements (median [interquartile range]: 37% [21- LEARN MORE: @ICUnutrition @emma-ridley 1. Ridley EJ, Parke RL, Davies AR, et al. What Happens to Nutrition Intake in the Post-Intensive Care Unit Hospitalization Period? An Observational Cohort Study in Critically Ill Adults. JPEN J Parenter Enteral Nutr 2019; 43: 88-95. 2018/06/21. DOI: 10.1002/jpen.1196. 2. Merriweather JL, Salisbury LG, Walsh TS, et al. Nutritional care after critical illness: a qualitative study of patients' experiences. J Hum Nutr Diet 2016; 29: 127-136. 2014/12/20. DOI: 10.1111/jhn.12287. 3. Merriweather J, Smith P and Walsh T. Nutritional rehabilitation after ICU - does it happen: a qualitative interview and observational study. J Clin Nurs 2014; 23: 654-662. 2013/05/29. DOI: 10.1111/jocn.12241. 4. Chapple LA, Chapman M, Shalit N, et al. Barriers to Nutrition Intervention for Patients With a Traumatic Brain Injury. JPEN J Parenter Enteral Nutr 2017: 148607116687498. 2017/01/26. DOI: 10.1177/0148607116687498. © Dietitian Connection 31 Infuse | December 2019