Adequacy of oral intake in a private intensive care unit in Gauteng province

[摘要] The prevalence of DRM in acute care facilities is a common phenomenon that negatively impacts on patient mortality, morbidity and cost of treatment. However, it remains a widely under-recognised and under-treated problem. The aim of this study was to assess the adequacy of nutritional intake of exclusively orally fed patients admitted to the ICU in a private South African hospital in Alberton, Gauteng Province.An observational cross-sectional study was conducted over a period of 14 consecutive days. A total of 26 participants were recruited and included in the study and their oral intakes were followed up daily throughout their stay in the ICU to deliver a total number of 94 data collection points for comparison. The sample comprised of 15 male and 11 female participants. Majority of the participants were admitted to ICU as result of trauma, were between the ages of 20 and 40 years and spent less than 10 days in ICU. Fifty percent of the participants had a normal BMI between 20 �?24.9 kg/m2.Energy and protein requirements as well as total oral intakes in terms of energy and protein content, were calculated for each participant. For participants that were included in the study for more than one day, the average daily oral intake was calculated. Total oral intake included food received from the catering department, personal snacks and beverages as well as ONS. To assess the adequacy of nutritional intake, the nutritional content of consumed food and beverages was compared to requirements at the hand of energy and protein content.For the total sample (n=26) as well as the subgroup that received ONS (n=11), the median energy and protein intakes were inadequate, with and without ONS. The energy intake for the subgroup that did not receive ONS (n=15) was almost adequate at 98%, whilst protein intake was inadequate. Although the addition of ONS did not elevate energy and protein intake to adequacy in these two groups, the increase in energy and protein intakes were statistically significant for the total sample (n=26), as well as for the sub-group (n=11) that received ONS. When the sample was divided per BMI group, for the subgroup BMI < 30 kg/m2 (n=19) the median energy intake for energy and protein was inadequate with and without ONS. For the heavier subgroup (n=7), energy requirements were exceeded both without and with ONS while protein intake remained inadequate even with the addition of ONS. Therefore, the intake of energy was inadequate for all the subgroups, with and without ONS, except for the heavier subgroup where energy intake exceeded requirements, with and without ONS. Protein intake was inadequate for all the subgroups despite the addition of ONS.This study confirmed that, in general, the oral intakes of patients admitted to ICU is inadequate. It was confirmed that the prescription of ONS to optimise the oral intakes, is essential. However, specific consideration to optimise protein delivery without exceeding energy requirements in the critically ill obese patient, is necessary. Furthermore, the study highlighted the important role of a dedicated food service dietitian in the hospital setting.Recommendations for future research include the development of South African guidelines aimed at directing and monitoring adequate oral intakes of ICU patients, development of ONS to meet the specific nutritional requirements of the critically ill obese patient and suggestions to investigate the nutritional requirements and importance of optimal nutrition during the recovery phase. Finally, the researcher considers it necessary to develop a position statement outlying the specific role and responsibilities of the therapeutic dietitian versus the food service dietitian, highlighting the importance of a dedicated food service dietitian.

[发布机构] University of the Free State