Marjon Borgert

94 Chapter 5 EN intake during ICU admission in a large cohort of ICU patients. In addition we aim to identify subgroups of patients or areas within the EN practices where the daily EN intake is inadequate. This study might form the basis to develop strategies to support ICU sta to provide adequate EN, thereby minimizing the risk for malnutrition. MATERIALS & METHODS Setting This retrospective observational study was conducted in an ICU for adult patients in a university hospital in Amsterdam, the Netherlands. The ICU is a closed-format department and has 28-beds with a mixed surgical and medical patient population. Patients are under the direct care of the medical ICU team. The nurse-to-patient ratio is 1:1 or 1:2, depending on the patients’ severity of illness. Protocol for enteral nutritional feeding Our EN protocol is aimed at the early and continuous administration of EN (Supplementary File 1). The protocol includes instructions on when to start EN, directions to achieve the daily EN targets and directions to manage gastric retention. According to the EN protocol, patients’ individual EN requirements are reviewed on a daily basis by the intensivist. These requirements are adjusted according to changes in the clinical conditions of the patient and on the nutritional intake of the previous days. Additionally, twice a week an intensivist, who is an expert in nutritional support, together with a dietician, are monitoring the nutritional conditions of every admitted patient. The EN delivery starts as soon as possible after ICU admission in patients whose length of ICU stay is expected to be more than 24 hours with the exception of surgical patients. These patients do not receive nutrition on the day of surgery or on the rst day of ICU admission. Data collection Adult patients (≥ 18 years) admitted to the ICU from January 2012 to December 2014 were included in this study. Each bed is equipped with an electronic Patients Data Management System (PDMS) (Metavision, Ite medical Tiel), in which patient data is prospectively collected. Medical and nutritional data were extracted from this database. Data from patients with EN were used from admission until discharge from the ICU or with a maximum of 30 days. Other data we collected are age, gender, body length, last known body weight before hospital admission ICU and hospital length of stay, referral specialty in the ICU and Apache II.