‘‘If we could give every individual the right amount of nourishment and exercise,
not too little and not too much, we would have found the safest way to health”.
‘‘Hippocrates: Father of Medicine’’ [1].
Eating well is important for everyone’s health, well or ill. Providing appropriate
nutrition in the hospital setting is a particularly challenging task due to the diverse
dietary needs of the population. Food not only needs to be individualized to
everyone’s nutritional requirements, but also needs to be adjusted to different
age groups, as well as different medical conditions.
The importance of nutrition in the hospital setting cannot be overstated.
This is particularly true in the ICU. Critical illness is typically associated with a
catabolic stress state in which patients commonly demonstrate a systemic
inflammatory response. This response is coupled with complications of increased
infectious morbidity, multiorgan dysfunction, prolonged hospitalization, and
mortality.
During the past three decades, the understanding of the molecular and biological
effects of nutrients in maintaining homeostasis in the critically ill population has
made exponential advances. Traditionally, nutrition support in the critically ill
population was regarded as adjunctive care designed to provide exogenous fuels
to support the patient during the stress response.
This traditional perspective has evolved from support to therapy that focuses on
three main objectives:
1-to preserve lean body mass,
2-to maintain immune function,
3-to avert metabolic complications.[2]
Recently, these goals have become more focused and nutrition support teams
were created. Their intervention aims at attenuating the metabolic response to
stress, preventing oxidative cellular injury, and favorably modulating the immune
response.
All these measures may reduce disease severity, diminish complications, decrease
length of stay in the ICU, and favorably impact patient outcome.
But, despite all these efforts, various nutrition surveys in hospitals continue to
suggest that 40% to 50% of patients, particularly those in the intensive care unit,
have a moderate to severe degree of malnutrition, with its significant negative
impact on clinical outcomes.
Indeed several shortcomings can be still identified in the nutritional care of
hospitalized patients from the moment of admission to discharge and beyond.
[1] brainyquote.com/quotes/authors/h/hippocrates.html
[2] Crit Care Med 2009 Vol. 37, No. 5
All that being said, and in order to better understand and evaluate the current
usage of nutrition support in our community and to design fruitful educational
sessions on nutrition support, please take a few minutes to fill the following
questionnaire:
1.
Practitioner:
Physician
Pharmacist
Dietitian
Nurse
Other
2.
Name of institution:
3.
Academic affiliation:
University Hospital
4.
Location of institution:
Beirut
Mount Lebanon
North
Bekaa
South
University Affiliation
Private Hospital
5.
Number of beds:
10 to 50
51 to 100
101 to 200
> 201
6.
What is the approximate percent occupancy in your institution:
25% to 50%
51% to 75%
76% to 100%
7.
Have you used a specific nutritional screening test?
Yes
No
8.
If yes which test?
……
9.
What is the approximate percentage of patients placed on oral supplements at
any given time during their hospital stay:
0% to 10%
11% to 20%
21% to 30%
31% to 40 %
> 41% (Specify: ……)
10. What
is the approximate percentage of patients placed on enteral feeding
(Gavage and ready to hang formulas) within 48h of ICU admission?
0% to 10%
11% to 20%
21% to 30%
31% to 40 %
> 41% (Specify: ……)
11. What
is the approximate percentage of patients placed on enteral feeding
(Gavage and ready to hang formulas) at any given time during their hospital
stay:
0% to 10%
11% to 20%
21% to 30%
31% to 40 %
> 41% (Specify: ……)
12. What
is the approximate percentage of patients on enteral feeding that are on
ready to hang formulas:
0% to 25%
26% to 50%
51% to 75%
76% to 100%
13. What is the approximate percentage of patients sent on home EN:
0% to 10%
11% to 20%
21% to 30%
31% to 40 %
> 41% (Specify: ……)
14. What
is the approximate percentage of patients sent on home oralm
supplements:
0% to 10%
11% to 20%
21% to 30%
31% to 40 %
> 41% (Specify: ……)
15. What is the trend in usage of EN support over the past 5 years:
Unchanged
Decreasing trend
Increasing trend:
0% to 5%
6% to 10%
11% to 20%
21% to 40 %
> 41% (Specify: ……)
16. What
is the approximate number of patients who are receiving PN during their
hospital stay:
0 to 2 / week
3 to 5 / week
6 or more / week
17. How
many patients have you approximately sent on home PN during the past
2 years:
………………
18. What is the trend in usage of PN support over the past 5 years ?
Unchanged
Decreasing trend
Increasing trend:
0% to 5%
6% to 10%
11% to 20%
> 21%
19. What
is the approximate percentage of patients prescribed PN in the first
week of ICU admission?
0% to 10%
11% to 20%
21% to 50%
> 51%
20. What
is the approximate percentage of patients kept without nutrition
support (NPO, off EN, and off PN) for more than 7 days in your institution:
0% to 5%
6% to 10%
11% to 20%
> 21%
21. How many beds in your ICU:
………………..
22. What is the approximate percentage of patients on EN support in your ICU?
0% to 5%
6% to 10%
11% to 20%
> 21%
23. What is the approximate percentage of patients on PN support in your ICU?
0% to 5%
6% to 10%
11% to 20%
> 21%
24. What ready to hang EN formulas do you currently use?
o
o
o
o
25. What PN formulations do you currently use?
o
o
o