94 CHAPTER 6 6.2 MATERIALS & METHODS 6.2.1 Standard nutritional care practice In this mixed ICU, a standard care protocol based on the international ESPEN/ ASPEN guidelines is used to provide adequate nutritional support during and after ICU-admission.19,20 According to this protocol, patients at risk for malnutrition (expected LOS ≥48 hours and/or enteral or total parenteral nutrition at ICU-admission) receive nutritional support led by nurses and a dedicated intensivist, which consists of the following steps: (1) assessment of nutritional status by SNAQ score21 or bioimpedance-derived phase angle22; (2) defining energy and protein requirements (1.2-1.5 g/kg/d protein - 25 kcal/kg/d energy); (3) defining feeding route; (4) d efining necessary dietary supplementation (for example: thiamine/vitamin b complex in case of suspected malnutrition); (5) start, step-wise increase, and end of nutritional support. As part of this standard protocol, nutritional support is continued by a clinical dietician after ICU-discharge. This dedicated dietician provides information regarding specific nutritional needs when a patient is discharged home or to a care facility. After 3-months, patients and their informal caregivers are invited to visit the specialised outpatient clinic where they are seen by a physical therapist, a dedicated ICU-nurse and an intensivist. Throughout the patient journey, dietary support is supervised by clinical dieticians and a hospital-wide team of nutrition experts. 6.2.2 Study design and population This prospective, observational study was performed in the ICU-ward of the main tertiary teaching hospital in the Frisian region in the northern part of the Netherlands, between May and November 2019. Long-stay adult patients admitted to the ICU with a length of stay (LOS) ICU of ≥ 48 hours were asked to participate. The use of this cut-off value was based on our previously published research and aimed to exclude patients that were less severely ill, such as patients admitted for one or two days after elective surgery, per protocol, without serious complications, as this group may be at lower risk for long-term health problems.2
RkJQdWJsaXNoZXIy MjY0ODMw