Optimization of Oral Diet in Critically Ill Patients

Personalized Adapted Diet and Nutritional Follow-up With Therapeutic Education in Critically Ill Patients : Impact on Calorie and Protein Deficit, on Weight, Mortality, and Quality of Life

The purpose of the present study is to evaluate the effects of a personalized oral diet in the critically ill patients during ICU stay and after as compared usual oral diet.

This is a prospective randomized controlled single center clinical trial. This trial include patient over 18 year hospitalized in ICU and ventilated more than 5 days and/or with denutrition after 5 days of no food intake in ICU without shock and/or respiratory distress. The randomization is awebsite randomization with stratification on age, presence of sepsis at inclusion, renal failure The day of the resumption of the oral feeding (J0), realization of a protocolized swallowing test then randomization and creation of a control and intervention group

Control group:

• Nutrition in resuscitation according to medical prescription: food recovery with a light meal consisting of soup and desserts and evolution to a normal meal according to the capabilities of patients
• Daily quantification of ingesta (calories and proteins) by a dietitian until the exit resuscitation. Comparison with caloric-protein targets.
• Nutritional evaluation before the release of resuscitation.

Intervention group:

• NAP: "Customized Adapted Nutrition"
• Daily quantification of ingesta (calories and proteins) by a dietitian until the exit resuscitation. Comparison with caloric-protein targets.
• Therapeutic education.
• Nutritional evaluation before the release of resuscitation.
• Creation at the exit of resuscitation of a nutritional linkage sheet with instructions food

The prospects for optimizing oral replenishment are multiple:

• reduce morbidity and mortality within 3 months after a stay in intensive care unit.
• improve autonomy and quality of life after a stay in intensive care.
• improve the privileged relationship with the patients' families.
• strengthen links within the resuscitation team and with downstream services.
• Educate patients on a nutritional level.

Inclusion Criteria:

- patient 18 yo or above hospitalized in ICU and ventilated more than 5 days and/or with severe denutrition after 5 days of no food intake in ICU without shock and/or respiratory distress

Exclusion Criteria:

• age under 18 yo, pregnancy,
• protected patients
• moribund patient (life expectancy of 48h or below),
• patient with disorders of swallowing
• tracheostomy
• patient with shock and/or respiratory distress