Nutrition practices in intensive care units: nutritionDay from 2007-2021

In intensive care units (ICU), patients who are not able to eat or are considered at nutritional risk typically receive medical nutrition therapy based on partially contradictory guidelines as well as the strategies used in large randomized trials. The aim of this study is to analyze patient data from the nutritionDay project in intensive care to describe current clinical approaches to nutrition support worldwide, in Europe and in the group of German-speaking countries, the DACH (i.e., Germany, Austria, Switzerland) region. From 2007-2021, data of 18,918 adult patients in 1595 ICUs from 63 different countries were included in this cross-sectional study. The aim was to recruit all patients present in ICUs. Median stay in the ICU was 4 days on nutritionDay. Little difference in patient characteristics were observed between worldwide, Europe, and the DACH region. Patient were 64 years old, 40% female, 50% ventilated, 29% sedated, and 10% needed renal replacement therapy. A quarter of the patients died in hospital within 60 days and about half of the patients had been discharged home. Enteral nutrition was given twice as frequently as parenteral nutrition (48% versus 24%). Many patients received oral nutrition (39%) and a substantial number received no nutrition support (10%). Parenteral nutrition was used more frequently in Europe than in other world regions, the lowest use being observed in North America. The amount of nutrition given is very similar in all regions regardless of the nutrition route with about 1500 kcal and 60 g of protein per day. A clear association with body weight was not observed and the variation around the median was very large with half of patients receiving amounts 25% below or above the median. Upon completion of data entry, the nutritionDay project allows each ICU to download a unit report summarizing data that allows comparison with worldwide data in numeric and graphical form to permit easy benchmarking of medical nutrition therapy.