Abstract
BackgroundThe rapid increase in disease-related malnutrition makes it almost impossible for healthcare practitioners and policymakers to keep up with its negative consequences. Consequently, healthcare organisations and decision-makers have called for accelerated and double-duty actions to manage the double burden of malnutrition. Guidelines standardise nutritional practices, improve nutritional status and reduce hospitalisation duration and save costs.ObjectivesA systematic scoping review of the nutritional therapy practice guidelines and implementation in critically ill adults was undertaken to identify the breadth of literature on the topic, summarise findings and identify gaps.MethodsA comprehensive search strategy was designed and implemented to identify eligible studies from eight databases, websites of organisations, government departments and academic platforms. Reference lists of included studies were also searched for relevant studies. We assessed the quality of included studies, completed a descriptive numerical summary and analysed them.ResultsIn total, 1555 titles and 101 abstracts were screened, 65 underwent full text review and 19 were retained for data extraction. Studies scored average to high on quality assessment, and a summary of characteristics of included studies is presented. Nutritional therapy practice guidelines are considered a proactive strategy for enhanced, uniform and individualised nutritional practices and factors that influence implementation were identified.ConclusionsA gap exists between research recommendations and actual practice despite the growing interest in implementation of nutritional therapy guidelines in critical care. There is a need for more research to evaluate the practicality of available guidelines.
Highlights
The rapid increase in disease-related malnutrition makes it almost impossible for healthcare practitioners and policymakers to keep up with its negative consequences
200 critically ill adult patients who remained nil per os (NPO) > 48 h after admission to the intensive care unit (ICU). 100 patients were enrolled into the pre-implementation group, and 100 patients were enrolled into the postimplementation group
There was poor adherence to recommendations for the use of EN formulas enriched with fish oils, glutamine supplementation, timing of supplemental parenteral nutrition and avoidance of soybean oil-based parenteral lipids
Summary
The rapid increase in disease-related malnutrition makes it almost impossible for healthcare practitioners and policymakers to keep up with its negative consequences. Malnutrition is very common in acutely ill patients, occurring in 30% – 50% of hospitalised patients and the number may be higher in critically ill patients, and is associated with increased complication risk, high healthcare costs and increased long-term mortality (Jones et al 2008:301; Wischmeyer 2013:2) This is attributed to critically ill patients having decreased volitional nutrition intake and being completely dependent on their care providers for their nutritional needs. The phrase ‘critically ill’ refers to patients ≥18 years of age, with a high severity of disease score, with one or more organ dysfunctions and needing a single or multiple invasive therapeutic intervention(s) (Boniatti et al 2011) These patients always receive poor nutrition for a prolonged period as nutritional therapy is often only an afterthought on care rounds in most severely ill patients (Wischmeyer 2013:2)
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