ABSTRACT
BACKGROUND: Multidisciplinary nutrition teams can help guide the use of parenteral nutrition (PN), thereby reducing infectious risk, morbidity, and associated costs. Starting in 2007 at Harborview Medical Center, weekly multidisciplinary meetings were established to review all patients receiving PN. This study reports on observed changes in utilization from 2005-2010. MATERIALS AND METHODS: All patients who received PN from 2005-2010 were followed prospectively. Clinical data and PN utilization data were recorded. Patients were grouped into cohorts based on exposure to weekly multidisciplinary nutrition team meetings (from 2005-2007 and from 2008-2010). Patients were also stratified by location, primary service, and ultimate disposition. RESULTS: In total, 794 patients were included. After initiation of multidisciplinary nutrition meetings, the rate of patients who started PN decreased by 27% (relative risk [RR], 0.73; 95% confidence interval [CI], 0.63-0.84). A reduction in the number of patients receiving PN was observed in both the intensive care unit (ICU) and on the acute care floor (RR, 0.64; 95% CI, 0.53-0.77 and RR, 0.80; 95% CI, 0.64-0.99, respectively). The rate of patients with short-duration PN use (PN duration of <5 days) declined by 30% in the ICU (RR, 0.70; 95% CI, 0.51-0.97) and by 27% on acute care floors (RR, 0.73; 95% CI, 0.51-1.03). CONCLUSIONS: Weekly multidisciplinary review of patients receiving PN was associated with reductions in the number of patients started on PN, total days that patients received PN, and number of patients who had short-duration (<5 days) PN use.
Subject(s)
Nutritionists , Parenteral Nutrition/methods , Patient Care Team/organization & administration , Adult , Aged , Female , Hospitalization , Hospitals , Humans , Intensive Care Units , Length of Stay , Male , Middle Aged , Nutrition Policy , Prospective Studies , Time FactorsABSTRACT
Supplementation of micronutrients after burn injury is common practice in order to fight oxidative stress, support the immune system, and optimize wound healing. Assessing micronutrient status after burn injury is difficult because of hemodilution in the resuscitation phase, redistribution of nutrients from the serum to other organs, and decreases in carrier proteins such as albumin. Although there are many preclinical data, there are limited studies in burn patients. Promising research is being conducted on combinations of micronutrients, especially via the intravenous route.
Subject(s)
Burns/drug therapy , Dietary Supplements , Micronutrients/therapeutic use , Oxidative Stress/drug effects , Burns/metabolism , Humans , Immunocompromised Host , Micronutrients/administration & dosage , Wound Healing/drug effectsSubject(s)
Burns/psychology , Burns/therapy , Adrenergic beta-Antagonists/therapeutic use , Anabolic Agents/therapeutic use , Autografts , Bandages , Burns/economics , Debridement , Depression/diagnosis , Dietary Proteins/administration & dosage , Dietary Supplements , Energy Intake , Fluid Therapy , Glutamine/administration & dosage , Hospital Costs , Humans , Hyperglycemia/prevention & control , Interview, Psychological , Multiple Organ Failure/prevention & control , Nutritional Requirements , Nutritional Status , Occupational Therapy , Oxandrolone/therapeutic use , Patient Outcome Assessment , Physical Therapy Modalities , Psychiatric Status Rating Scales , Quality of Life , Recovery of Function , Reimbursement Mechanisms , Resuscitation , Return to Work , Schools , Skin Transplantation , Societies, Medical , Stress Disorders, Post-Traumatic/diagnosis , Stress Disorders, Traumatic, Acute/diagnosis , Stress, Physiological , Surveys and Questionnaires , Survivors , Weight Loss , Withholding Treatment , Wound Healing , Wound Infection/prevention & controlABSTRACT
Adequate nutrition support is a key component in achieving favorable outcomes for the critically ill patient. Significant evidence supports starting enteral nutrition rather than parenteral nutrition as early as possible after injury to promote positive outcomes. Evidence shows that enteral nutrition improves patient outcomes and decreases intensive care unit length of stay by improving splanchnic blood flow, moderating the metabolic response, sustaining gut integrity, and preventing bacterial translocation from the gut to the bloodstream. Implementing early enteral nutrition can be challenging. This article describes the rationale for early enteral nutrition, the evidence that favors enteral nutrition over parenteral nutrition, barriers to delivery of full enteral nutrition, and an evidence-based protocol developed at Harborview Medical Center to promote appropriate support. The role of the registered dietitian on the health care team in facilitating appropriate feeding is discussed. In addition, we will describe emerging nutrition therapies including the use of antioxidants, addition of the amino acid glutamine, use of immune-enhancing enteral formulas, and the potential role of probiotics that show promise in improving patient outcome.
