gms | German Medical Science

Background: Severely burned patients pose a number of clinical challenges for medical doctors and dietitians to achieve optimal nutrition practice. The objective of this study was to describe nutrition practices for burn patients in intensive care units (ICU) relatively to the most recent ESPEN and SCCM/ASPEN guidelines and highlight the variation in practice and what is “best achievable”.

Methods: In 2014-15, we prospectivelyenrolled 283 mechanically ventilated patients who stayed in the ICU (N=14) for at least 72 hours. Data collected included information on the estimation of energy requirements, goal protein range, feeding route, enteral nutrition (EN) initiation, and nutrition delivered. We describe average and range of site practices.

Results: Relative to recommendations of the ESPEN and SCCM/ASPEN, we report average, best, and worst site performance on key nutrition practices. In particular, adherence was high for the use of enteral nutrition 90,5% of patient-days (site average range 79.2%-97.0%). However, significant practice gaps were identified for other recommendations, mainly for measurement of requirements 7.7% of patient-days (site range 0.0%-93.3.0%), provision of glutamine 22.4% of patient-days (site range 0.0%-61.8%) and zinc 14.5% of patient-days (site range 0.0%-82.3%) and selenium supplementation. Similar deviations from recommendations were observed for time point for meeting energy 35.3% of patient-days (site range 0.0%-80.0%) or protein needs 34.3% of patient-days (site range 0.0%-80.0%). Average nutritional adequacy was 64.9±40.0% for energy (best site: 80.2%, worst site: 42.0%) and 65.6±42.4% for protein (best site: 87.3%, worst site: 43.6%).

Conclusion: The present findings indicate that despite high adherence to some recommendations, there still exist a large gap between many recommendations and actual practice in ICUs, and consequently nutrition therapy for burn patients is suboptimal.