Dietetic-led interventions in critically ill adults that influence outcome: A scoping review.

Abstract

Critically ill patients face malnutrition risks, making nutrition management challenging. Dietitians play a crucial role in the intensive care unit (ICU) by applying their expertise to address these challenges. This review examines dietitian-led interventions and their impact on patient outcomes. A scoping review of MEDLINE, Embase, CINAHL, EBSCO, Web of Science, and ProQuest databases from January 1995 to July 2023 was conducted. Studies involving dietitian-led interventions in adult critical care were included. Data extraction followed Joanna Briggs Institute methodology, focusing on study design, population, and interventions. Of 751 studies, 39 met the inclusion criteria. Most studies were observational, with only three interventional trials. Dietitian-led interventions included (1) guideline development and implementation, (2) individualized nutrition treatment, and (3) enteral nutrition tube insertion. Outcomes were classified into (1) patient clinical outcomes (ICU stay duration, mechanical ventilation, infections, cost savings, readmissions, mortality, adverse effects, and glycemic control) and (2) nutrition-related outcomes (nutrition initiation, energy and protein delivery, gastrointestinal tolerance, parenteral nutrition use, and appropriate dietetic referral). Dietitian-led interventions improved nutrition outcomes and may have contributed to better clinical outcomes. Future research should prioritize reporting core outcomes, including nutrition status and physical function, to further quantify the effectiveness of dietitians in ICU care and enhance their recognition within the multiprofessional team.