Dietitians provide information on long-term management and feeding processes and expert cost-effective advice on appropriate nutritional supplements. Dietetic assessment and planning facilitates long-term recovery and nutritional health.
48% of patients fed by tube are fed this way as result of neurological problems. Incorrect management of enteral feeding is extremely expensive. An AHP multidisciplinary approach to tube-feeding patients will enable a quicker return to oral intake. Many PEG patients inappropriately remain on PEG feeding for the rest of their lives in cases where community multidisciplinary teams have not been commissioned.
Allied Health Professional stroke commissioning toolkit, NHS London March 2012.
Bedside placement of Nasointestinal tubes
In a dietitian led study, patients fed via a Cortrak electromagnetically guided nasointestinal tube (EGNT) or 14 French-gauge nasogastric tube plus prokinetics were retrospectively compared. The staff time and cost of the feeding tube was significantly less than staff time and costs of metoclopramide/erythromycin administration (£115 vs. £205). There was also an increase in enteral nutrition delivery and reduction in lost feeding days in the EGNT group.
Taylor SJ et al. Treating Delayed Gastric Emptying in Critical Illness: Metoclopramide, Erythromycin, and Bedside (Cortrak) Nasointestinal Tube Placement(JPEN J Parenteral Enteral Nutr. 2010; 34:289-294).
The intensive care dietitian can make a difference
The presence of a dedicated ICU dietitian reinforces implementation of nutrition protocols, resulting in improved nutrition management. Combining a protocol and dedicated dietitian results in increased energy delivery and decreased energy deficit. The dietitian interventions significantly improved the day 7 energy balances. This was accomplished by identifying energy deficit, earlier introduction of nutrition treatments and by suggesting the use of combined observation of insufficient enteral feeding.
Soguel L et al. Energy deficit and length of hospital stay can be reduced by a two-step quality improvement of nutrition therapy: The intensive care unit dietitian can make the difference. Crit Care Med, 2012, 40;412-418.
Replacement of 1% with 2% Propofol
A critical care dietitian led study showed that there would be a £1.76/day or 9% cost saving if ICU’s switched from 1% to 2% Propofol. However, the main benefit was that reducing the lipid load increased the protein, carbohydrate and micronutrient delivery from feed without risk of overfeeding. Reducing the lipid load also decreased risk from Propofol-infusion syndrome.
Taylor SJ et al. Propofol Use Precludes Prescription of Estimated Nitrogen Requirements. J Intensive Care Med 2005; 20; 111.