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Critical Illness

CI: Scope of Guideline (2012)

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

The purpose of this guideline is to provide an evidence-based summary of effective practice in the nutrition management for the critically ill.

Recommendations have been formulated to promote positive clinical outcomes specific to clinical practice decisions pertinent to nutrition of the critically ill. The major focus of this guideline is to provide protocols for the delivery and monitoring of enteral nutrition (EN) support.

The Guideline is intended to be used by dietetic practitioners involved in the nutritional care of the critically ill. Dietetic practitioners in non-critical care settings or alternative healthcare settings may also find this guideline helpful for patients requiring EN or PN. The guidelines are intended to provide healthcare practitioners with direction based on the current science for nutrition of the critically ill in order to promote positive clinical outcomes.

Guideline Category

Assessment of Therapeutic Effectiveness, Treatment

Clinical Specialty

Critical Care, Nutrition

Intended Users

Registered Dietitians, Advanced Practice Nurses, Health Care Providers, Nurses, Pharmacists, Physician Assistants, Physicians, Respiratory Care Practitioners, Speech-Language Pathologists, Students

Guideline Objective(s)

Overall Objective

  • To provide MNT guidelines for nutrition of the critically ill to enhance delivery and reduce complications.
 
Specific Objectives
  • To define evidence-based recommendations for the provision of EN by registered dietitians (RDs) in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical and nutritional elements
  • To reduce variations in practice among RDs
  • To provide the RD with evidence-based practice recommendations to adjust the MNT or recommend other therapies to achieve positive outcomes
  • To enhance the quality of life (QoL) for the patient, utilizing customized strategies based on the individual's nutritional needs
  • To promote optimal nutrition support within cost constraints of the healthcare environment.

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adult critically ill patients requiring or eligible for EN support in the intensive care unit (ICU). The evidence for the guideline did not specifically examine populations that were exclusively patients with burns. These guidelines are not applicable to pediatric populations.

Interventions and Practices Considered

The Critical Illness guideline is based on the Academy of Nutrition and Dietetic's Nutrition Care Process and Model, which involves the following steps. Terms relevant to the treatment of critically ill patients come from the International Dietetics & Nutrition Terminology (IDNT) Reference Manual: Standardized Language for the Nutrition Care Process. Third Edition.

  • Nutrition Assessment

  • Nutrition Diagnosis

  • Nutrition Intervention

  • Nutrition Monitoring and Evaluation.

This guideline addresses topics that correspond to the following areas of the Nutrition Care Process.

I. Referral to a Registered Dietitian

II. Medical Nutrition Therapy

A. Nutrition Assessment

Below are the nutrition assessment terms related to critical illness from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Third Edition.

  • Food/nutrition-related history to include nutrient intake,  nutrient administration, and factors affecting access to nutrition support-related supplies
  • Nutrition-focused assessment including:
    • Anthropometric measurements
    • Biochemical data, medical tests and procedures
    • Nutrition-focused physical findings
    • Client history to include medical history and treatments.

B. Nutrition Diagnosis

Beloware common nutrition diagnoses related to critical illness from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process,  Third Edition.

  • Inadequate energy intake
  • Excessive energy intake
  • Inadequate oral intake
  • Inadequate intake from EN or parenteral nutrition (PN) infusion
  • Excessive intake from EN or PN infusion
  • Less than optimal EN or PN infusion
  • Malnutrition
  • Altered GI function.

C. Nutrition Intervention (Planning and Implementation)

Below are the nutrition interventions related to critical illness from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process,  Third Edition.

Individualized nutrition prescription based on current reference standards and dietary guidelines and the patient/client’s health condition and nutrition diagnosis:

  • Formula/solution
  • Insert enteral feeding tube
  • Site care
  • Feeding tube flush
  • IV Fluids
  • Nutritional needs of patient
  • Medical status
  • Current clinical status.

D. Monitoring and Evaluation

Monitoring and evaluation are critical components in reassessing the adequacy and success of the nutrition support intervention.

Below are the nutrition monitoring and evaluation terms related to critical illness from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Third Edition.

  • Individualized prescription based on monitoring criteria for tolerance of EN.
  • Nutrient intake
  • Nutrition-related ADLs and IADLs
  • Nutrition-focused physical findings.
  • Body composition/growth/weight history.