Impact of an interdisciplinary nutrition support team (NST) on the clinical outcome of critically ill patients. A pre/post NST intervention study.

Abstract

Intensive care unit (ICU) patients are at particular risk for malnutrition with major impact for outcome and prognosis. Nutrition support teams (NST) have been proposed to improve nutrition care in ICU patients. To assess the effectiveness of an interdisciplinary NST on anthropometry and clinical outcome of ICU patients. Before NST implementation, we assessed 120 patients (before NST group; SAPS II score 44±16), afterwards 60 patients (after NST group), of whom 29 received NST guidance (after NST+group; SAPS II 65±19) and 31 not (after NST - group; SAPS II, 54±16). The primary outcome parameter was length of stay in the hospital (hospital-LOS). Severity of disease was assessed by the APACHE II score and the nutritional risk (NUTRIC) score. NST intervention resulted in a more pronounced improvement of disease severity (APACHE II, from 27±8 to 18±6, p<0.001; NUTRIC, from 7±2 to 4±2, p<0.001) compared to no NST intervention (APACHE II from 24±7 to 21±7, p<0.05; NUTRIC from 6±2 to 5±2, p<0.01). The mean hospital-LOS was not reduced, neither in the NST intervention group nor in the control group without NST intervention. NST intervention failed to improve nutritional status or mortality compared to no NST intervention. In our study the NST intervention had a positive effect on disease severity, but failed to improve mortality, hospital-LOS or nutritional status in ICU patients, likely because of a large patient heterogeneity. ClinicalTrials.gov (NCT02200874).