Impact of the guidelines on clinical practice of artificial nutrition in intensive care unit after cardiovascular and thoracic surgery

Objective. - To analyze the impact of an artificial nutrition program in postanaesthesia. intensive. care unit. Study design. - Observational study. Patients and methods. - Patients with length of stay greater than 8 days after cardiovascular and thoracic surgery: Group 1: 34 patients (4-month period in 2000); group 2: 15 patients (2-month period in 2001); group 3: 40 patients (4-month period in 2003). Between these 3 periods, informations of physicians and written protocol in order to improve their nutritional knowledge. After analysis of variance (P < 0.05). Newman-Keuls tests to compare themselves each groups. Results. - Anthropometric, demographic and clinical parameters were similar in the 3 groups. Energic intakes were less. than 80% of basal energetic expenditures in 33%, 33 and 22% of patient, respectively (NS). Caloric and nitrogen intakes were less than recommended, respectively 19 +/- 6 (mean +/- SD), 21 +/- 7 and 21 +/- 8 kcal/kg/24 h and 102 +/- 32, 111 +/- 31 and 92 +/- 40 mg/kg/24 h (NS). However enteral nutrition was administered in 49, 40 and 100% of patients respectively (P < 0.001). The glucid/lipid ratio improved from 0.47 in group 1 up to 0.68 in group 3 (P < 0.0001). Vitamins, oligoelements and clinical and biological monitoring of artificial nutrition improved (P < 0.001). Conclusion. - A clinical audit demonstrated an improvement in artificial nutrition parameters but no significant change in others. (c) 2006 Elsevier Masson SAS. Tous droits reserves.