Nutrition for critically ill patients

Nutrition is an integral component of general care for critically ill patients, and numerous randomized trials have addressed research questions related to the optimal feeding route, formulation, dose, and timing of initiation. The mission of the free website www.criticalcarenutrition.com is 'to improve the practice of nutrition support in the critical care setting through knowledge translation', with specific objectives for knowledge generation, synthesis and translation. Most of the website's resources are devoted to the dissemination of a recently published multidisciplinary evidence-based clinical practice guideline (CPG) on nutritional support for mechanically ventilated critically ill adults [1]. The guideline was peer funded and developed with the participation of multiple academic, professional society, and industry stakeholders. The related website is operated by Critical Care Nutrition, a group of Canadian intensivists and dietitians with diverse backgrounds (intensive care, surgery, nutrition, clinical epidemiology). For practicing clinicians, including intensive care unit (ICU) directors and dietitians, the most useful website features are the Tools & Training Kit (designed to facilitate local CPG implementation) and the Nutrition Survey. Implementation tools include a training manual (text and flow diagrams that highlight important CPG recommendations), sample order sets for glycemic control and enteral feeding, printable summary pocket cards, and tips on organizing an implementation workshop. Nine slide presentations on various nutrition topics (e.g. 'Optimizing the Benefits and Minimizing the Risk of Enteral Nutrition' and 'Nutritional Support in Severe Acute Pancreatitis') are available as zipped PowerPoint files and can be modified for local use. Overall, the materials are comprehensive, practical, and novel. They are especially appealing given the traditional ineffective approach of relying on journal publication as the primary method of knowledge translation. However, an enthusiastic but administratively inexperienced intensivist or dietitian may find it extremely challenging to build a nutritional quality improvement program using the website tools. Additional useful information would include the following: a specific 'how-to' manual for implementing the CPG (which might include a downloadable lecture, a sample project timeline, and estimated personnel, time and monetary requirements); links to general change management resources; and evidence of usability testing of the implementation tools to match the rigor of the CPG development process. The Nutrition Survey is a quality improvement tool that an ICU can use initially to compare its nutrition practice to that in other centres and subsequently to assess the impact of a quality improvement initiative on adherence to best practices. Patient data are entered on the website either …