P068 - ADDRESSING ICU NUTRITION INADEQUACY: AN EXPERT-EVIDENCE-EXPERIENCE (EEE) APPROACH

P068

ADDRESSING ICU NUTRITION INADEQUACY: AN EXPERT-EVIDENCE-EXPERIENCE (EEE) APPROACH

R. R. Chada^1,*, B. Samant², H. Dev³, A. Chattopadhay⁴, E. Canday⁵, V. Gorey⁶, S. V⁷, S. Pandey⁸, S. Sahoo⁹, G. Thangaraj¹⁰, V. Krishnan¹¹, S. Sonawale¹², N. Joshi¹²

¹Dietetics, AIG Hospitals, Hyderabad, ²Dietetics, Kokilaben Dhirubai Ambani Hospital, Mumbai, ³Critical Care, Apollo Hospital , Bangalore, ⁴Critical Care, CMRI Hospital, Kolkata, ⁵Dietetics, Sir H. N. Reliance Foundation Hospital, Mumbai, ⁶Dietetics, Apollo Hospital , Navi Mumbai, ⁷Dietetics, Apollo Hospital , Madurai, ⁸Dietetics, Medanta Medicity, Gurugram, ⁹Dietetics, Apollo Hospital , Bhubneshwar, ¹⁰Critical care Medicine, Kovai Medical Center & Hospital, Coimbatore, ¹¹Department of Dietetics, SRM Institutes for Medical science, Chennai, ¹²Medical & Scientific Affairs, Dr. Reddy's & Nestle Health Science, Mumbai, India

Rationale: Protein–energy deficit is highly prevalent in ICU patients, affecting 43%–88% of the critically ill. Studies show that fewer than 10% receive ≥80% of recommended nutrition in the first 72 hours. Interruptions are common-55% due to diagnostic procedures lasting 2–6 hours long. This study aimed to gather nationwide data on reasons for inadequate enteral nutrition in ICUs and sought expert guidance on strategies to improve nutritional adequacy.

Methods: A series of Expert, Evidence and Experience (EEE) meetings were held with 220 dietitians across India to explore current practices, barriers to early initiation of enteral feeding, and causes of interruptions after initiation.  

Results: 70% reported that over 40% of their ICU patients were malnourished, while 95% said patients achieved less than 75% of their nutrition targets. Key barriers included delayed initiation, feeding intolerance, and absence of multidisciplinary approach. Haemodynamic instability and vasopressor use (42%), followed by GI issues (32%) were the most common reasons for delayed initiation. Interruptions after initiation were identified, and 44% opined that feeding intolerance was the major reason followed by 21% for diagnostic procedures. Expert guidance concluded with a 4-Step approach to improve enteral nutrition adequacy- 1. Establish a Nutrition Support Team (NST) and feeding protocols with regular audits. 2. Identify high-risk patients early using structured screening and assessment tools. 3. Timely initiation of enteral nutrition, within 24 hours of ICU admission. 4. Adopt Volume-Based feeding protocols to overcome feeding interruptions.

Conclusion: Nutrition inadequacy in ICUs is a significant challenge. A multi-pronged, evidence-based approach, including early screening, timely feed initiation, structured feeding protocols, and a multidisciplinary team is essential to improving nutrition delivery and patient outcomes.

Disclosure of Interest: None declared