REACHING NUTRITIONAL TARGETS IN CRITICALLY ILL PATIENTS. MANAGEMENT AND MONITORING. OUR EXPERIENCE

Abstract

There is growing concern about clinical nutrition in critically ill patients. The latest guidelines identify nutritional targets and monitoring tools to provide an accurate management. Objective of the study was to evaluate benefits of a standardized protocol of intensive monitoring to fulfill clinical standards. A retrospective study was conducted in 2 groups of ICU-patients hospitalized in following periods, before and after the application of the early nutritional protocol. All patients with medical conditions at admission and subject to Enteral Nutrition were included. We analysed 250 patients divided in 2 Clusters, without contraindications to Enteral Nutrition. In Cluster 1 (n=160), patient feeding was guided only by clinical judgment. In Cluster 2 (n=90), enteral nutrition was handled according to the intensive monitoring and management protocol. Demographic and severity criteria were comparable. The main results are summarised in Graph 1. Results suggest that the application of the local protocol allows to reach nutritional standards in critically ill patients and earlier feeding. Furthermore, nutritional discontinuance related to uncertain intolerance (elevated gastric residual volume, vomiting..) was drastically reduced, decreasing the number of potential underfeeding days.