Improving the Practice of Nutrition Therapy in the NRITLD Critically Ill Patients: An International Quality Improvement Project

Hashemian, Seyed Mohammadreza; Cahill, Naomi; Murch, Lauren; Wang, Miao; Jamaati, Hamid Reza; Malekmohammad, Majid; Farzanegan, Behrooz; Tabarsi, Payam; Marjani, Majid; Sadr, Makan; Fahimi, Fanak; Bagheri, Ahmad; Ghiasi, Farzin; Asadi, Poopak; Hatami, Behzad; Chitsazan, Mandana; Najafi, Arvin; Jamshidi, Mahdieh; Hedayat, Kowsar; Radmand, Golnar; Bayanzadeh, Amir; Masjedi, Mohammad Reza; Heyland, Daren

Improving the Practice of Nutrition Therapy in the NRITLD Critically Ill Patients: An International Quality Improvement Project

Authors

Seyed Mohammadreza Hashemian ¹

Naomi Cahill ²

Lauren Murch ²

Miao Wang ²

Hamid Reza Jamaati ¹

Majid Malekmohammad ³

Behrooz Farzanegan ¹

Payam Tabarsi ⁴

Majid Marjani ⁵

Makan Sadr ¹

Fanak Fahimi ¹

Ahmad Bagheri ¹

Farzin Ghiasi ¹

Poopak Asadi ¹

Behzad Hatami ¹

Mandana Chitsazan ¹

Arvin Najafi ¹

Mahdieh Jamshidi ⁶

Kowsar Hedayat ⁶

Golnar Radmand ¹

Amir Bayanzadeh ⁷

Mohammad Reza Masjedi ¹

Daren Heyland ⁸

¹ Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences

² Critical Care Nutrition Team in Ontario, Canada

³ Lung Transplantation Research Center

⁴ Mycobacteriology Research Center

⁵ Clinical Tuberculosis and Epidemiologic Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran- Iran

⁶ Chronic Respiratory Disease Research Center, NRITLD, Shahid Beheshti University of Medical Sciences,

⁷ Department of General Surgery, Academic Medical Center, Cologne, Germany

⁸ Department of Medicine and Epidemiology at Queen's University, Director of Research for the Critical Care Program and the Director of the Clinical Evaluation Research Unit at the Kingston General Hospital, Kingston, Canada

Abstract

Background: In previous decades several studies have been performed demonstrating that providing appropriate nutritional support to intensive care unit patients affects complications, time of mechanical ventilation, length of ICU stay, and risk of death. In this study we provided a report of nutrition statuses in Masih Daneshvari's ICU as compared to 156 ICUs from 20 countries that participated in an international nutrition survey. Materials and Methods: All patients admitted to an intensive care unit during a specified one-month period who required artificial nutrition were included in this study. Characteristics of patients, performance of nutrition practices, and ICU outcomes were registered for all patients and compared with data from 156 other intensive care units from various countries around the world. Results: Twenty patients, of which 11(55%) were males and 9(45%) were females, were included in this study. The median age was 50.5 yrs (IQR: 40.5- 56.0). Seventeen (85%) of them had EN nutrition only, 2(10%) had PN nutrition only, and 1(5%) had both EN and PN nutrition during their stay in the ICU. The adequacy of calorie intake was 67.6% (vs. 61.1% in all 157 ICUs) and the adequacy of protein intake was 84.9% (vs. 56.7% in 157 ICUs). Conclusion: In our ICU, enteral feeding was superior to parenteral feeding. Also we considered early initiation of enteral feeding within 48 hours following ICU admission. We just used polymeric formula during this study. As a result of formula variation limits, we overestimated calories and protein needs. Glutamine and Selenium supplementations have not been used yet for patient in our ICU, regardless of their proven benefits in oxidative stress conditions like pulmonary diseases. Therefore, limited use of supplementations like selenium is inevitably among the disadvantages of Masih Daneshvari Hospital’s ICU, which is a tertiary-care center for chronic pulmonary diseases.

Keywords

Nutrition

Quality improvement

Critical care

Intensive care unit