Effectiveness of Registered Dietitian-Led Management of Early Nutritional Support in the Emergency Intensive Care Unit: A Retrospective Observational Study

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Abstract Background Appropriate nutritional management in critically ill patients has a positive impact on prognosis. The Japanese Guidelines for Nutritional Therapy of Critically Ill Patients issued in 2016 recommend that enteral nutrition be started within 48 h of admission to the intensive care unit (ICU) and that an enteral nutrition protocol be developed. In November 2021, we assigned a dietitian exclusively to our emergency ICU (EICU), created a flowchart for initiating early nutritional support and an early enteral nutrition protocol, and strengthened the management system for early nutritional supports. This new system was evaluated based on the nutritional management status and safety of patients admitted to the EICU. Methods This retrospective observational study included patients who stayed in the EICU for at least 5 days between April 2021 and May 2022. Patients admitted before and after the system was implemented were defined as the control group (n = 56) and early support group (n = 58), respectively. Primary and secondary endpoints were compared among the groups. The primary endpoints were the time until enteral nutrition initiation after admission to the EICU and the rate of enteral nutrition initiation within 48 h. The secondary endpoints were the rate of enteral feeding up to 7 days after admission to the EICU, the rate of complications in tube feeding management, the number of times a nutrition management plan was proposed to the primary care physician, and outcomes. Results The time taken to start enteral nutrition after admission was shorter in the early support group. The enteral nutrition energy and protein sufficiency rates increased with nutritional supports. In terms of complications during tube feeding, the incidence of diarrhea was lower in the early support group. No significant differences in outcomes were observed between the groups. Conclusions The early nutritional support system in our EICU effectively reduces the time it takes to initiate enteral nutrition, thereby improving the nutritional sufficiency rate, and decreases the incidence of diarrhea during tube feeding. Our findings highlight the significance of dedicating a dietitian exclusively to lead the nutritional management system in the EICU.

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