Critical Illness

CI: Scope of Guideline (2006)

Guideline Scope Characteristics

Below you will find a list of characteristics that describe the Scope of this Guideline.

Disease/Condition(s)

The purpose of this guideline is to provide an evidence-based summary of effective practice in the nutrition management for the critically ill.

Recommendations have been formulated to promote positive clinical outcomes specific to clinical practice decisions pertinent to nutrition of the critically ill. The major focus of this guideline is to provide protocols for the delivery and monitoring of enteral nutrition (EN).

The guideline is intended to be used by dietetic practitioners involved in the nutritional care of the critically ill. These guidelines may also serve as a valuable resource for dietetic practitioners providing medical nutrition therapy (MNT) for patients in other non-critical care healthcare settings or alternative healthcare settings requiring EN. These guidelines are intended to provide healthcare practitioners with direction based on the current science for nutrition of the critically ill in order to promote positive clinical outcomes.

Guideline Category

Assessment of Therapeutic Effectiveness, Treatment

Clinical Specialty

Critical Care, Nutrition

Intended Users

Registered Dietitians, Advanced Practice Nurses, Health Care Providers, Nurses, Pharmacists, Physician Assistants, Physicians, Respiratory Care Practitioners, Speech-Language Pathologists, Students

Guideline Objective(s)

Overall Objective

  • To provide MNT guidelines for nutrition of the critically ill to enhance delivery and reduce complications.
 
Specific Objectives
  • To define evidence-based recommendations for the provision of EN by registered dietitians (RDs) in collaboration with other healthcare providers
  • To guide practice decisions that integrate medical and nutritional elements
  • To reduce variations in practice among RDs
  • To provide the RD with data to make recommendations to adjust the MNT or recommend other therapies to achieve outcomes
  • To enhance the quality of life for the patient, utilizing customized strategies based on the individual's nutritional needs
  • To define the highest quality of care within cost constraints of the current healthcare environment.

Target Population

Adult (19 to 44 years), Middle Age (45 to 64 years), Aged (65 to 79 years), Male, Female

Target Population Description

Adult critically-ill patients requiring or eligible for EN support in the intensive care unit (ICU). The evidence for the guideline did not specifically examine populations that were exclusively patients with burns. These guidelines are not applicable to pediatric populations.

Interventions and Practices Considered

I. Referral to a Registered Dietitian
 
II. Medical Nutrition Therapy
A. Nutrition Assessment

Below you will find the nutrition assessment terms related to critical illness care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition assessment terms, click here.

  1. Medical history to include assessment of gastrointestinal function and relevant laboratory values for nutritional status.
  2. Nutrition-focused assessment including:
  • Height, weight, BMI
  • Nutrition history
  • Lifestyle habits, including physical activity and tobacco or substance abuse
  • Medical issues impacting nutrition therapy; to include medical or surgical history
  • Considerations of comorbid conditions and need for additional modifications in nutrition care plan.
B. Nutrition Diagnosis

Below you will find the nutrition diagnoses related to critical illness care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition diagnoses, click here.

Hypermetabolism (NI-1.1)
  • Hypometabolism (NI 1.3)
  • Inadequate energy intake (NI-1.4)
  • Excessive intake (NI-1.5)
  • Inadequate oral food or beverage intake (NI-2.2)
  • Inadequate intake from EN or parenteral nutrition (PN) infusion (NI-2.3)
  • Excessive intake from EN or PN infusion (NI-2.4)
  • Inappropirate infusion of EN or PN infusion (NI-2.5).

C. Comprehensive Intervention (Planning and Implementation)

Below you will find the nutrition interventions related to critical illness care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition interventions, click here.

            Individualized prescription based on:

      1. Nutritional needs of patient
      2. Medical status
      3. Current clinical status.
D. Monitoring and Evaluation

Below you will find the nutrition monitoring and evaluation terms related to critical illness care from International Dietetics & Nutrition Terminology Reference Manual: Standardized Language for the Nutrition Care Process, Second Edition. To view a complete list of all nutrition monitoring and evaluation terms, click here.

  1. Individualized prescription based on monitoring criteria for tolerance of EN.