The Impact of a Dietitian in the Implementation of Nutrition Recommendations During Intensive Care

The Impact of Involving a Dietitian in the Implementation of Expert Recommendations Concerning Nutrition During Intensive Care on Energy Balance

The main objective of this study is to evaluate the impact of the intervention of a dietician on the energy balance accumulated over seven days of intensive care.

Energy balance is defined as the difference between the target recommended energy and total calorie intake actually received.

This is a randomized-cluster study; participating centers are randomized into experimental and control groups.

The secondary objectives of this study are to compare the impact of the intervention of a dietician on:

• daily and accumulated energy balance at the end of the intensive care unit (ICU) stay
• deficits in protein intake per day, accumulated over 7 days, and accumulated for the ICU stay
• intake of vitamins, trace elements and pharmaco-nutrients per day
• predominant route of nutrition administration (enteral / parenteral / mixed)
• the course of the stay: duration of mechanical ventilation, organ failure, the ICU stay, number of days on antibiotics
• the presence / absence of complications: mortality, on catheter bacteremia, ventilator acquired pneumonia, other infections, bedsores, episodes of hyper-or hypoglycemia
• presence/absence of diarrhea
• costs related to the management of malnourished patients in terms of enteral and parenteral nutritional therapy, dietary supplements, antibiotics and sedatives as well as the costs of ICU stay and those related to diarrhea and sores

Inclusion Criteria:

• The patient must be insured or beneficiary of a health insurance plan
• Patients hospitalized in intensive care for an expected period greater than 72 hours, and for whom sufficient eating after 72 hours of hospitalization is deemed unlikely upon admission.
• Patients receiving mechanical ventilation and having at least one organ failure other than respiratory failure, defined by a SOFA score greater than 2.

Exclusion Criteria:

• The patient is under judicial protection
• The patient (or his/her legal representative or "trusted-person") indicates they do not wish to participate in the study
• It is impossible to correctly inform either the patient or his/her "trusted person"
• The patient is participating in another study, or is in an exclusion period determined by another study
• Moribund patients or those for whom death appears imminent (within 24 hours)
• Survival to Day 28 unlikely due to uncontrollable comorbidities
• Patients with advanced directives issued expressing the wish to not be resuscitated