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Protein prescription and delivery practices in critically ill adults: A survey of Australian and New Zealand intensive care dietitians

  • G.C.E. Lyons
    Affiliations
    Nutrition and Dietetics, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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  • M.J. Summers
    Affiliations
    Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia

    Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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  • T.J. Schultz
    Affiliations
    Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia

    Adelaide Nursing School, The University of Adelaide, Adelaide, South Australia, Australia
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  • K. Lambell
    Affiliations
    Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia

    Nutrition Department, Alfred Health, Melbourne, Australia
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  • E.J. Ridley
    Affiliations
    Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia

    Nutrition Department, Alfred Health, Melbourne, Australia
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  • K. Fetterplace
    Affiliations
    Allied Health Department (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia

    The University of Melbourne, Melbourne Medical School, Department of Medicine and Radiology, Royal Melbourne Hospital, Melbourne, Australia
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  • R. Yandell
    Affiliations
    Department of Clinical Dietetics, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, Australia
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  • L.S. Chapple
    Correspondence
    Corresponding author at: 4G751, Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia.
    Affiliations
    Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia

    Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, Australia
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Published:September 20, 2021DOI:https://doi.org/10.1016/j.aucc.2021.08.004

      Abstract

      Background

      Protein provision is thought to be integral to attenuating muscle wasting in critical illness, yet patients receive half of that prescribed. As international guidelines lack definitive evidence to support recommendations, understanding clinicians’ views relating to protein practices is of importance.

      Objectives

      The objective of this study was to describe Australia and New Zealand intensive care unit (ICU) dietitians’ protein prescription and perceived delivery practices in critically ill adults, including common barriers and associations between ICU clinical experience and protein prescriptions for different clinical conditions.

      Methods

      A 42-item descriptive quantitative survey of Australian and New Zealand intensive care dietitians was disseminated through nutrition and ICU society e-mailing lists. Data were collected on respondent demographics and reported protein practices including questions related to a multitrauma case study. Data were analysed using descriptive and content analysis and reported as n (%). Fisher's exact tests were used to compare experience and protein prescriptions.

      Results

      Of the 67 responses received (one excluded due to >50% missing data), more than 80% of respondents stated they would prescribe 1.2–1.5 g protein/kg bodyweight/day for most critically ill patients, most commonly using European Society of Clinical Nutrition and Metabolism (ESPEN) guidelines to support prescriptions (n = 61/66, 92%). Most respondents (n = 49/66, 74%) thought their practice achieved 61–80% of protein prescriptions, with frequently reported barriers including fasting periods (n = 59/66, 89%), avoiding energy overfeeding (n = 50/66, 76%), and gastrointestinal intolerance (n = 47/66, 71%). No associations between years of ICU experience and protein prescriptions for 14 of the 15 predefined clinical conditions were present.

      Conclusions

      Australian and New Zealand ICU dietitians use international guidelines to inform protein prescriptions of 1.2–1.5 g/kg/day for most clinical conditions, and protein prescriptions do not appear to be influenced by years of ICU experience. Key perceived barriers to protein delivery including avoidance of energy overfeeding and gastrointestinal intolerance could be explored to improve protein adequacy.

      Keywords

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