NEW YORK (Reuters Health) - Implementation of evidence-based nutritional management improved the outcomes in critically ill intensive care unit (ICU) patients, researchers in California report in the April issue of Chest.

ICU patients often receive inadequate nutritional support, the authors explain, and malnutrition in the ICU can lead to increased morbidity, mortality, and length of ICU stay.

In the first study of its kind, Dr. Juliana Barr and colleagues from the Department of Veterans Affairs Palo Alto Health Care System and Stanford University investigated whether a comprehensive ICU nutritional management protocol would optimize nutritional support of critically ill patients and affect clinical outcomes.

Implementation of the protocol brought a nonsignificant increase in the percentage of patients receiving enteral nutrition (78%), compared with patients treated prior to implementation (68%), the authors report. However, after adjusting for age, gender, illness severity, admission type (medical or surgical), and nutritional class, patients were more than twice as likely after implementation of the protocol to receive enteral nutrition, the report indicates.

Moreover, the researchers note, after adjusting for a variety of other contributing factors, patients in the nutritional protocol implementation group required significantly fewer days of mechanical ventilation and had a 56% lower risk of death, compared with the pre-implantation group.

"The early institution of nutritional support and the use of enteral nutrition improve clinical outcomes in critically ill patients," Dr. Barr's group concludes.

"Future research should focus on strategies for improving the nutritional management of surgical ICU patients and ICU patients with moderate-to-severe malnutrition at baseline and focus on strategies for improving compliance with nutritional management protocols in an ICU setting," they recommend.

"Development and implementation of protocols require a multidisciplinary approach," write Dr. Gary P. Zaloga from Indiana University School of Medicine and Dr. Larry Bortenschlager from Clarian Health Partners in Indianapolis, in a related editorial. "Even when there is buy-in, we have found that use of protocols requires an ongoing education program and feedback to clinicians on adherence and performance of the protocol."

In the commentators' experience, "there is much higher compliance in protocols when patients are primarily managed by the ICU teams that developed the protocols."

Chest 2004;125:1446-1457,1195-1197

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