Nutrition, impacting on morbidity and mortality, is regarded by us, as an essential component in the care of the critically ill patient.
In the Alfred ICU, nutrition is considered and provided within a team-based approach, the aim being to optimize and individualize all aspects of nutritional care for each ICU patient.
Nutrition is one of the items of the ICU daily checklist. The multi-disciplinary daily ICU ward round (including intensivists, ICU nurses, ICU dietitians and ICU pharmacists) is pivotal in the overall care plan and implementing key decisions to optimise nutrition delivery and achieve nutrition goals.
A dietitian works in each pod of the Alfred’s ICU, providing a seven day and on-call dietetic service. This allows for the rapid commencement of nutrition when a new patient is admitted.
The Alfred ICU has 3 indirect calorimetry machines which are used on the most severely unwell ICU patients to optimise nutritional targets, as well as for research purposes.
Further, the management of the nutritional aspects of care of the critically ill patient in ICU has been improved in 2012 by the addition of pages to our dashboard in which the dietitians can enter calculations and daily intake, but more importantly by a summary page which charts nutritional input vs target input for both energy and protein which allows all staff to quickly appraise the nutritional progress of the patient.
Current research interests of the ICU Nutrition team include: Supplemental Parenteral Nutrition, Indirect Calorimetry, nutrition for patients receiving Extra-corporeal Membrane Oxygenation and nutrition requirements in Traumatic Brain Injury.
The Alfred ICU also participates in the International Nutrition Survey on an annual to bi-annual basis which is an international benchmarking and quality improvement tool. Based on results of the 2009 and 2011 surveys, the Alfred ICU was judged the Best of the Best, on 2 separate occasions, from over 150 ICUs.
In 2010, the Alfred’s Department of Intensive Care held the Inaugural Nutrition in the Critically Ill Symposium in conjunction with the Department of Nutrition. This was a 2 day meeting held at the Park Hyatt, Melbourne, the aim of which was to provide the ICU nutrition community with the latest research and clinical practice updates. Key invited speakers were Prof Daren Heyland (Kingston, Canada), A/Prof Marianne Chapman (Adelaide), A/Prof Peter Devitt (Adelaide) and Ms Lyn Gillanders (Auckland). Baxter were the main sponsors.
In 2011, a 2nd Symposium was held. This was a 1½ day program as part of a 3 day joint meeting with AuSPEN. The International invited speakers were Prof Mette Berger (Lausanne, Switzerland) and Prof Alastair Forbes (London, UK). A/Prof Marianne Chapman (Adelaide), A/Prof Michael O’Leary (Sydney), Prof Lindsay Plank (Auckland), Mr Alan Spencer (Gold Coast) and Mrs Kerry McIlroy (Auckland) were the invited speakers from Australia and New Zealand. Baxter were again the main sponsors.
The 2012 Symposium is shaping up as our best ever. We have invited two prominent international speakers: Pierre Singer from Israel and Daren Heyland from Canada. Added to this we have the results of the Early PN study being presented by Gordon Doig and we have Adam Deane visiting us from Adelaide with his latest ideas on nutrient absorption. We have introduced an “ask the experts” session and we will also be utilising the latest handheld remote voting devices to allow registrants to have a say “on the spot” and we will be able to see their collective response live on screen.
We have also had consistent requests for guidelines and protocols and we will be providing our latest version to all attendees.
(See courses for more details).