PW04 - OPTIMIZING MEDICAL NUTRITION THERAPY IN CRITICAL CARE – AN ICU DIETITIAN CAN MAKE THE DIFFERENCE

PW04

OPTIMIZING MEDICAL NUTRITION THERAPY IN CRITICAL CARE – AN ICU DIETITIAN CAN MAKE THE DIFFERENCE

A. Brito-Costa^1,2,*, C. Sousa¹

¹Unidade de Nutrição, ULS São José, ²Laboratório de Nutrição, Faculdade de Medicina - Universidade de Lisboa, Lisbon, Portugal

 

Rationale: Critically ill patients are at high risk of malnutrition but the adequacy of nutritional support still remains a widespread problem. This study aims to measure the nutritional and clinical impact of a dedicated intensive care unit (ICU) dietitian.

Methods: This cohort analysis comprises data from 164 critically ill adult patients. Demographic, clinical and anthropometric data, energy and protein needs and delivery, length of ICU and hospital stay, and mortality were collected from all patients during the first week of ICU in two consecutive selected periods of 3 and 6 months (with and without dietitian support, respectively). Patients were excluded if they did not complete 3 ICU days, if interruptions in nutritional support >72 h due to medical/surgical reasons or when under oral diet (making impossible to calculate real intake). The nutrition protocol was based on the European guidelines. Non-nutritional calories were calculated. Data was statistically analyzed through SPSS v26 (SPSS Inc., Chicago, IL, USA).

Results: The mean (standard deviation) age of the study participants was 59 (17.4) yrs and 62% were male. 57% and 19% of the patients were admitted by a medical cause and trauma, respectively.

Patients analyzed in period with dietitian support (N=64) were more severely ill (SOFA score 8.9 (3.76) vs 7.3 (4.06), p=0.022) and had longer ICU stay (18 (37.9) vs 13 (12.1) days, p=0.015) than patients from period without dietitian support (N=100).

Overall, energy and protein supply and relative adequacy were all superior in period with dietitian support. Specifically, energy adequacy in the first 3 days from admission (74.5 (39.73) vs 61.7 (32.27)%, p=0.049), energy provided between D4 and D5 (18.9 (8.98) vs 15.5 (9.35) kcal/kg/day, p=0.048), protein provided between D4 and D5 (0.8 (0.46) vs 0.6 (0.39) g/kg/day, p=0.009) and energy adequacy between D4 and D5 (120.2 (56.99) vs 92.7 (52.81), p=0.012) were all significantly higher in patients with dietitian support vs without dietitian support.

Furthermore, the proportion of underfed patients (energy delivery < 50% needs) was significantly higher during all periods analyzed in the 1st week of ICU in the absence of dietitian support (D1-D3 69% vs. 50%, p=0,021; D4-D5 30% vs 14%, p=0,038; D6-D7 23% vs 16%, p=0,040).

Conclusion: The presence of a dedicated ICU dietitian significantly improved the nutrition adequacy in ICU patients, even in a cohort with greater illness severity. These findings highlight that integrating dietitians into critical care teams can lead to more effective support.

References: Dresen E, Bear DE, DePriest A, et al. Role of dietitians in optimizing medical nutrition therapy in cardiac surgery patients: A secondary analysis of an international multicenter observational study. JPEN J Parenter Enteral Nutr. 2025;49(4):476-487. doi:10.1002/jpen.2755

Derouin E, Picard G, Kerever S. Dieticians' practices in intensive care: A national survey. Clin Nutr ESPEN. 2021;45:245-251. doi:10.1016/j.clnesp.2021.08.017

Taylor B, Renfro A, Mehringer L. The role of the dietitian in the intensive care unit. Curr Opin Clin Nutr Metab Care. 2005;8(2):211-216. doi:10.1097/00075197-200503000-00017

Terblanche E. The role of dietitians in critical care. Journal of the Intensive Care Society. 2018;20(3):255-257. doi:10.1177/1751143718774715

Disclosure of Interest: None declared