Dieticians' practices in intensive care: A national survey.

Abstract

A real public health problem, namely, malnutrition in the hospital, also concerns intensive care patients. The diagnosis and prevention of malnutrition are major issues in the multidisciplinary management of patients hospitalized in the intensive care unit (ICU). To our knowledge, few data describe dietary management in French ICUs, and few international scientific publications mention professional practices or how dieticians are integrated in this type of specialized and technical sector. The objective of this study is to identify the practices of dieticians in the ICU at a national level. This study is based on the use of an electronic questionnaire distributed to registered dietician nutritionists practising in intensive care. A total of 185 dieticians participated in this survey, which allowed us to describe the practices of 174 ICUs. Among the respondents (n=185), 95% were women with a median age of 37 [31; 52]. The respondents graduated a median of 14 years ago [8.5; 30] and have been practising in intensive care for 5 years [2; 10]. With a median number of 12 beds [10; 18] (n=174), the ICU has a median of 0.1 [0.05; 0.25] (n=185) full-time equivalent dieticians. The solicitation of the dietitian is variable in different ICUs. Nevertheless, information from dietitians is frequently sought. Dietary initiatives mainly concern acts relating to oral nutrition and enteral nutrition. A nutrition protocol was present in 38% of the ICUs (n=174). The integration felt by dieticians in the service is heterogeneous. Statistical analysis reveals that a dietitian who spends more than 4h a week in the ICU, has a nutrition protocol in his or her department and does not encounter any obstacles, such as the absence of a doctor's prescription, is more likely to be integrated into an ICU. This research work has made it possible to describe and make visible the role and involvement of dieticians working in ICUs in France and oversea departments and territories. Proposals to increase the involvement of dieticians in these sectors were reported at the end of this analysis.