Worldwide Survey of Nutritional Practices in PICUs

Objective: To assess current nutritional practices in critically ill children worldwide. Design: A two-part online, international survey. The first part, the survey, was composed of 59 questions regarding nutritional strategies and protocols (July-November 2013). The second part surveyed the point prevalence of nutritional data of patients present in a subgroup of the responding PICUs (May-September 2014). Setting: Members of the World Federation of Pediatric Intensive and Critical Care Societies were asked to complete the survey. Subjects: Pediatric critical care providers. Interventions: Survey. Measurements and Main Results: We analyzed 189 responses from 156 PICUs in 52 countries (survey). We received nutritional data on 295 patients from 41 of these 156 responding PICUs in 27 countries (point prevalence). According to the survey, nutritional protocols and support teams were available in 52% and 57% of the PICUs, respectively. Various equations were in use to estimate energy requirements; only in 14% of PICUs, indirect calorimetry was used. Nutritional targets for macronutrients, corrected for age/weight, varied widely. Enteral nutrition would be started early (within 24 hr of admission) in 60% of PICUs, preferably by the gastric route (88%). In patients intolerant to enteral nutrition, parenteral nutrition would be started within 48 hours in 55% of PICUs. Overall, in 72% of PICUs supplemental parenteral nutrition would be used if enteral nutrition failed to meet at least 50% of energy delivery goal. Several differences between the intended (survey) and the actual (point prevalence) nutritional practices were found in the responding PICUs, predominantly overestimating the ability to adequately feed patients. Conclusion: Nutritional practices vary widely between PICUs worldwide. There are significant differences in macronutrient goals, estimating energy requirements, timing of nutrient delivery, and threshold for supplemental parenteral nutrition. Uniform consensus-based nutrition practices, preferably guided by evidence, are desirable in the PICU.