Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition
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Multicenter Study
Improving the provision of enteral nutrition in the intensive care unit: a description of a multifaceted intervention tailored to overcome local barriers.
Tailoring interventions to address identified barriers to change may be an effective strategy to implement guidelines and improve practice. The purpose of this article is to describe the development and implementation of a tailored intervention to overcome barriers to enterally feeding critically ill patients. ⋯ This stepwise process to developing and implementing an intervention tailored to barriers is promising and could be considered by dietitians and other providers seeking to improve nutrition practice.
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Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure (REE) in the critically ill patient. The use of predictive equations to develop nutrition regimens can be problematic in the critical care setting, because the effects that disease, injury, and stress have on REE are often varied and unpredictable. IC testing ensures that the specific conditions of the critically ill patient are taken into account, thereby preventing potential complications from over- and underfeeding. ⋯ Given the importance of predicting REE in the critically ill patient, it is paramount that more healthcare professionals incorporate IC testing into practice. A multidisciplinary approach is helpful in developing a well-established clinical practice. Nutrition support clinicians can promote optimal nutrition management by being well-informed and able to provide evidence-based recommendations for the use of IC.