Multi-faceted strategy improves nutritional support for ICU patients, but not outcomes

A strategy to change practice in intensive care units was effective in implementing earlier nutritional support for critically ill patients, but the change did not result in a reduced risk of death or reduced length of stay in the ICU, according to a study in the December 17 issue of JAMA, the Journal of the American Medical Association.

Previous studies have found that early nutritional support, provided within 24 hours of injury or intensive care unit (ICU) admission, is a key component in the treatment of critically ill patients and may reduce the risk of death. But early nutritional support varies widely between ICUs, and up to 40 percent of eligible patients may remain unfed after 48 hours in the ICU, according to background information in the article.

"Evidence-practice gaps are common in clinical practice, with 30 percent of hospitalized patients receiving care inconsistent with current best evidence. Evidence-based guidelines (EBGs) help reduce evidence-practice gaps by promoting awareness of interventions of proven benefit and discouraging ineffective care. However, the ICU is a complex multidisciplinary environment, and reducing evidence-practice gaps through the successful implementation of an EBG in such an environment is difficult," the authors write. They add that evidence supporting whether guidelines can improve ICU feeding practices and patient outcomes is contradictory.