Nutritional support vital to recovery in PICU patients

January 12th, 2015

There are many treatments for critically ill patients. Among the treatments, providing early nutritional support, via the intestine, to critically ill adults has shown effectiveness in the healing process. With this in mind, researchers decided to investigate enteral nutrition and caloric requirements (CR) among critically ill children.

The research, published in the Journal of the Academy of Nutrition and Dietetics,¹ used data collected from the medical records from five pediatric intensive care units (PICUs) and a multisite clinical database. The medical records came from 1349 patients, age 30 days to 18 years old, who were admitted between January 1, 2007 and December 31, 2008 and remained in the PICU for 96 hours or more.

"Our main objective was to examine the practice of early documentation of estimated caloric requirement in the medical record of critically ill children to determine if this would have any effect on their daily caloric intake and the route of nutrition being used to provide them with nutritional support," says lead investigator Martin Wakeham, MD, FAAP, Assistant Professor of Pediatrics, Pediatric Critical Care, Medical College of Wisconsin, Children's Hospital of Wisconsin, Milwaukee. "We hypothesized that there would be a higher total daily caloric intake and more frequent use of enteral nutrition when a CR is estimated and documented in the medical record within 48 hours of PICU admission."

The data revealed that nearly 50 percent of the patients had a documented CR. The findings of the study included:

• 50% of the patients had a documented CR;
• These patients were younger and had a higher risk of mortality than those patients without CR;
• These patients were more likely to receive enteral nutrition on each of the first four days of admission to the PICU;
• These patients had a higher total daily caloric intake on each of the first four days of their stay in the PICU; and
• A registered dietitian determined the documented CR in more than 95% of the cases, suggesting the value of possible inclusion of registered dieticians in medical teams.

"A CR documented in the medical record is evidence that at least a member of the health care delivery team included nutritional support and therapy in the treatment plan for that particular patient. Likewise, not having a CR present in the medical record might be evidence that the subject of nutritional therapy was never addressed in those patients," says Dr. Wakeham. "Another interesting finding is that almost all of the CRs present early in the medical records were entered by a registered dietitian and not by an attending physician or other medical care provider. This finding illustrates the favorable and important impact that registered dietitians can have on the nutritional outcomes of PICU patients."

Source 1. Wakeham M, et al. Registered Dietitians Making a Difference: Early Medical Record Documentation of Estimated Energy Requirement in Critically Ill Children Is Associated with Higher Daily Energy Intake and with Use of the Enteral Route. Journal of the Academy of Nutrition and Dietetics.