Barriers to enteral nutrition on ICUs in Austria

Peer reviewed / Manuscript (original) submitted: 23. May 2021 / Revision accepted: 01. September 2021

Recommendations for clinical practice from a qualitative study

Introduction

Adequate nutrition, parenteral and/or enteral nutrition (EN) is a challenge on most intensive care units (ICU). For enteral nutrition just 59% (site average range, 20.5%-94.4%) of the prescribed energy and 60.3% (site average range, 18.6%-152.5%) for protein is delivered to the patient, resulting in underfeeding and malnutrition [1]. 38% of critically ill patients are either moderately or severely malnourished with 69% of patients experiencing a nutritional decline during their hospitalization [2]. This is associated with prolonged hospitalizations, higher infection rates and increased morbidity and mortality [3].

Malnutrition and muscle wasting are common problems on ICUs. This is because of the effects of catabolic hormones, an imbalance between intake and requirements, and a loss of lean body mass due to physical immobilization. Loss of lean body mass is associated with prolonged hospital stay and interferes with quality of life and functional capacity [3]. Enteral nutrition is the nutrition of choice if the oral uptake is insufficient [2].

Abstract

Background and Objective: 38% of critically ill patients on intensive care units are malnourished with 69% experiencing a nutritional decline in hospital. The objective was to identify barriers on Austrian intensive care units that prevent adequate enteral nutrition and to give recommendations for improvement.
Method: In a small qualitative study five semi-structured interviews with healthcare professionals from 4 different Styrian hospitals were conducted and cross-referenced with current scientific literature. Interviewees came from 4 different hospital-systems and 3 professions (2 registered dietitians, 1 registered nurse, 2 medical doctors) to obtain a broad insight into the topic.
Results: There seems to be no standard in hospitals and each institution handles enteral nutrition differently. The healthcare professionals considered nutrition important and appeared to be aware of some of the barriers identified. Educational and organizational barriers were common.
Conclusion: Changes in organizational practices, such as routine malnutrition screenings, automated tracking of nutrition therapy, individualized nutrition support, and the demand for better educating the professionals were only a few of the recommendations for improvement. Additional research is recommended.

Keywords: malnutrition, barriers, enteral nutrition, ICU – intensive care unit, recommendations, nutritional medicine, dietetics, nutrition therapy

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¹ This paper is an updated version of the e-poster presentation at the DGE Congress 2021.

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