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2008 International Nutrition Survey: Preliminary Results

2008 International Nutrition Survey: Preliminary Results. ANZICS/ AuSPEN Conference Sydney, Australia November 1, 2008. Critical Care Nutrition. . Mission Statement

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2008 International Nutrition Survey: Preliminary Results

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  1. 2008 International Nutrition Survey: Preliminary Results ANZICS/ AuSPEN Conference Sydney, Australia November 1, 2008

  2. Critical Care Nutrition . Mission Statement To improve practice of nutrition therapies in the critical care setting through knowledge generation, synthesis, and translation that ultimately leads to improved clinical outcomes for critically ill patients and improved efficiencies to our health care systems.

  3. Critical Care Nutrition Staff

  4. Andrew Day Biostatistician Siouxzy Morrison Project Leader AuSPEN/ANZICS Nutrition Research Fellow

  5. Achieving Best Practice:Quality Improvement What ought to be done? RCTs, Systematic Reviews, and Evidence-based practice guidelines What is done? How to change? Survey results KT Strategies What do we need to do differently? Benchmarking; Best Achievable Practice

  6. Objectives of International Audit • To determine current nutrition practice in the adult critical care setting (overall and subgroups) • Illuminate gaps between best practice and current practice • To identify interventions to target for quality improvement initiatives • To determine factors associated with optimal provision of nutrition • To determine what nutrition practices are associated with best clinical outcomes

  7. Methods • Prospective observational cohort study • Start date: 14 May 2008 • 20 consecutive critically ill patients • Data included: • Hospital and ICU demographics • Patient baseline information (e.g. age, admission diagnosis, APACHE II) • Baseline Nutrition Assessment • Daily Nutrition data (e.g. type of NS, amount NS received) • 60 day outcomes (e.g. mortality, length of stay)

  8. Methods Eligibility Criteria • ICU Site • >5 beds • Availability of individual with knowledge of clinical nutrition to collect data • Patient • In ICU > 72 hours • Mechanically ventilated within 48 hours

  9. Web based Data Capture System

  10. Who participated?: 159 ICUs Canada: 34 USA: 43 Europe and Other: 18 Asia: 27 Italy: 3 UK: 9* Ireland: 2 Portugal: 1 South Africa: 3 China: 20* Taiwan: 1 India: 6 Mexico:1 Brazil:3 Colombia:3 Peru:1 Paraguay:1 Venezuela:1 Latin America: 10 Australia & New Zealand: 27

  11. Who participated?Health practitioners 164 Registered Practitioners

  12. Who participated?Patients • Number of finalized patients per site • 18.0 (1-26) • Total number of finalized patients • 2486 • Days of observation per patient • 9.3 (3-12) • Total number of patient days in ICU • 23199 days • <3% missing data for ALL variables

  13. ICU Characteristics

  14. Patient Characteristics

  15. Patient 60 day Outcomes

  16. Baseline Nutrition Assessment

  17. Baseline Nutrition Assessment Methods Used to Calculate Energy Requirements

  18. Type of Nutrition Support “We strongly recommend the use of EN over PN” n=2486 patients

  19. Type of Nutrition: EN Only

  20. Type of Nutrition: PN Only

  21. Type of Nutrition: EN + PN

  22. Contraindication to EN(In Pts receiving PN) In critically ill patients with an intact GIT, we strongly recommend that PN not be used routinely

  23. Type of Nutrition: None

  24. Early vs Delayed EN

  25. Strategies to Optimize EN Delivery:Feeding Protocol

  26. Strategies to Optimize EN Delivery:Motility Agents

  27. Strategies to Optimize EN Delivery:Small Bowel Feeding

  28. Strategies to Optimize EN Delivery:Head of Bed Elevation

  29. Use of Pharmaconutrients Total % Patients Ever on EN receiving formula

  30. Arginine-supplemented formulas

  31. Glutamine supplementation

  32. Oxepa (All)

  33. Oxepa (ARDS)

  34. EN in Combination with PN % patients on EN where PN was started 72 hours after initiation of EN

  35. Strategies to Optimize PN Delivery:Use of Lipids no pt days on PN=2895

  36. % patients received Soybean oil based (LCTs)

  37. Strategies to Optimize PN Delivery:Use of IV Glutamine Use of PN glutamine in Patients receiving PN

  38. Intensive Insulin Therapy

  39. Intensive Insulin Therapy In all critically ill patients, we recommend avoiding hyperglycemia (blood glucose > 10 mmol/l)

  40. Overall Performance Adequacy of Nutrition Support = Calories received from EN + appropriate PN+Propofol Calories prescribed

  41. Overall Performance: Kcals

  42. Overall Performance: Kcals

  43. Overall Performance: Protein

  44. Adequacy of EN: Kcals

  45. Adequacy of EN: Protein

  46. Benchmarking

  47. Ranking Performance Figure 1.5 Overall Performance of Your Site

  48. Best of the Best Can you be the best in the International Nutrition Survey 2008 • Eligible sites: • Data on 20 critically ill patients • Complete baseline nutrition assessment • Presence of feeding protocol • No missing data or outstanding queries • Permit source verification by CCN • Awarded to ICU that demonstrate: • High nutritional adequacy • Adherence to the Canadian guidelines

  49. Best of the Best Can you be the best in the International Nutrition Survey 2008 • Eligible sites: • Data on 20 critically ill patients • Complete baseline nutrition assessment • Presence of feeding protocol • No missing data or outstanding queries • Permit source verification by CCN • Awarded to ICU that demonstrate: • High nutritional adequacy • Adherence to the Canadian guidelines

  50. Best of the Best • Rank all eligible ICUs by determinants • Multiply ranking by weighting • ICU with highest score is crowned ‘Best of the Best’

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