A Survey Of The Current Status Of Nutrition Support To Critical Ⅲ Patients In ICU Of Tertiary Hospitals In Hunan Province

Objective:This article aims to investigate the current status of nutrition support to critical ill patients in ICU of tertiary hospitals in Hunan province and Compare them with the Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Criticallyâ…¢Patients of 2009 (2009 Guidelines), finding out the problems and shortcomings during the treat course of nutrition support, helping to improve the present state of nutrition therapy quality and providing the clinical evedents for therapy in Hunan province.Methods:Sectional survey was conducted among eight ICUs of eight tertiary hospitals in Hunan province. Investigation questionnaires named as current status of nutrition support to critical ill patients in of tertiary hospitals in Hunan province were designed as research tools on the basis of lots of articles and consulting many experts. A database of information collected by questionnaires was established.Results:(1) 6 out of 8, that is 75% ICUs, involving in the survey, detailed instructions for enteral nutrition (EN) delivery were provided, where 2 ICUs (25%) were not. All the 8 ICUs involving in the survey had blood glucose control strategy and the targeting levels of blood glucose were less than 10 mmol/L2. All of 77 cases involving in the survey were involved in nutrition risk. And all of them accepted nutritional support treatments, including 42 cases (55.84%) for EN delivery,9 cases (16.88%) for parenteral nutrition (PN) delivery,26 cases (22.27%) for EN combined PN (EN+PN) delivery. The percentage of ICU-stay time under EN, EN+PN, PN were 52.59%,32.30% and 15.11% respectively.3.36 cases (46.75%) achieved early total EN (< 48 hrs),21 cases (27.27%) achieved early EN and PN and 15 cases (19.48%) achieved early total PN.5 patients (6.49%) did not receive any nutritional support in early 48 hours in ICU.42 patients under EN reached 51.51% of the goal for energy requirement on average during the ICU-stay; 26 patients under EN reached 121.33% of the goal for energy requirement on average; 9 patients under EN+PN which EN and PN provided 33.64% and 71.96% of the goal for energy requirement on average respectively. 42 patients under EN reached 35.20% of the goal protein requirement on average during the ICU-stay. monitoring gastric residual volumes (GRV)4. All 8 hospitals involving in the survey had detailed instructions about monitoring gastric residual volumes (GRV) for patients under EN delivery. And the critical value of GRV in 5 hospitals (62.5%) was less than or equal 150 mL; and more than or equal 250 mL in 3 (37.5%) hospitals.10 patients(14.71%) suspended EN because of gastric-intestinal intolerance, making 7.89% feeding time interrupted. 27 cases(41.54%) of 65 patients who was gastric-intestinal intolerance did not use stomach dynamic medicine; 11 cases (91.67%) of 12 patients who was not gastric-intestinal intolerance did use stomach dynamic medicine.37 cases (54.41%) of 68 patients under EN maintained the head-of-bed (HOB) to 30-45 degrees,59 patients (86.77%) adopted continuous drip given method.47cases (61.04%)of 77 patients used probiotics adjuvant therapy.30 cases (38.96%) did not use probiotics.50 patients (64.94%) use glutamine adjuvant therapy.27 cases (35.06%) did not use glutamine.Conclusion:Nutrition support to critical ill patients has been widely recognized and applied in ICU of tertiary hospitals in Hunan province, but there are still lots of problems compared with 2009 Guidelines:underfeeding and negative cumulated energy balance was found in patients with EN; overused and overfeeding of PN. Standard and concrete instructions should be implemented in hospital. Clinical doctors, nurses and other related healers in ICUs should make reasonable decisions as much as possible according to individual situation of patients and could never follow guidelines blindly.