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December 17, 2008

Implementing Nutrition Guidelines in the Critical Care Setting: A Worthwhile and Achievable Goal?

Author Affiliations

Author Affiliations: Departments of Community Health and Epidemiology (Ms Jones) and Medicine (Dr Heyland), Queen's University; and Clinical Evaluation Research Unit, Kingston General Hospital (Ms Jones and Dr Heyland), Kingston, Ontario.

JAMA. 2008;300(23):2798-2799. doi:10.1001/jama.2008.814

Consistently and repeatedly, over time and across settings, observational studies have documented the inabilities of critical care practitioners to adequately feed critically ill patients.1-3 Critically ill patients who receive less nutrition are more likely to experience increased complications, prolonged mechanical ventilation, longer time in the intensive care unit (ICU), and an increased risk of death.4 Patients who survive their critical illness often emerge in a weak and disabled condition that requires months to rehabilitate.5 Several randomized controlled trials (RCTs) and meta-analyses of RCTs suggest that strategies to improve the enteral delivery of calories reduce complications and improve survival.4 However, preliminary data from an international observational study suggest that wide variation in ICU feeding practices persists.3 Thus, efforts to improve the provision of calories and protein to critically ill patients are warranted.