The Impact of Implementation of a Nutrition Support Algorithm on Nutrition Care Outcomes in an Intensive Care Unit

Background: A nutrition support algorithm is an operational version of a guideline that is adapted to local requirements and easy to apply in clinical practice. The purpose of this study was to determine the impact of implementing a nutrition support algorithm on nutrition care outcomes in an intensive care unit (ICU) in Switzerland without a designated dietitian. Methods: The retrospective study included data collection on 2 cohorts of critically ill patients before (n = 56) and after (n = 56) implementation of a nutrition support algorithm based on the guidelines published by the Society of Critical Care Medicine and the American Society for Parenteral and Enteral Nutrition guidelines. Results: There were significant differences between groups for the mean delivery of total energy in the pre- vs postimplementation group (909 +/- 444 vs 1097 +/- 420 kcal/d; P = .023) and mean delivery of protein per day (35 +/- 17.9 vs 59.1 +/- 27.3 g; P < .001). For patients staying at least 7 days in the ICU, the cumulative energy deficit decreased from -5664 +/- 3613 kcal in the preimplementation group to -2972 +/- 2420 kcal (P = .011) in the postimplementation group. No significant differences in the route of feeding and timing of enteral nutrition initiation were found. Conclusions: Implementation of a nutrition support algorithm resulted in improved provision of energy and protein delivery. This may be further improved with routine nutrition assessment by a dietitian or a designated nutrition support team. (Nutr Clin Pract. 2012;27:793-801)