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Outcomes in a Pediatric Intensive Care Unit Before and After the Implementation of a Nutrition Support Team
Gisele Limongeli Gurgueira, MD, MSc*,
Heitor Pons Leite, MD, PhD ,
José Augusto de Aguiar Carrazedo Taddei, MD, DrPH and
Werther Brunow de Carvalho, MD, PhD*
From the * Pediatric Intensive Care Unit and the
Discipline of Nutrition and Metabolism,
Department of Pediatrics, Federal University of São Paulo, São
Paulo, Brazil
Correspondence: José Augusto de Aguiar Carrazedo Taddei, MD, DrPH,
Discipline of Nutrition and Metabolism, Department of Pediatrics, Federal
University of São Paulo, Rua Loefgreen 1647 Vila Clementino, São
Paulo 04040032, Brazil. Electronic mail may be sent to
limongeli{at}uol.com.br.
Background: We evaluated the effect of parenteral nutrition (PN)
and enteral nutrition (EN) on in–pediatric intensive care unit (PICU)
mortality before and after a continuous education program in nutrition support
that leads to implementation of a nutrition support team (NST).
Methods: We used a historical cohort study of infants hospitalized
for >72 hours at the PICU from 1992 to 2003. Five periods were selected (P1
to P5), considering the modifications incorporated into the program: P1,
without intervention; P2, basic themes and original articles discussion; P3,
clinical and nursing staff participation; P4, clinical visits; P5, NST. The
samples were compared in terms of sex, age, admitting service (ie, medical
vs surgical), prognostic index of mortality, length of stay (LOS),
duration of mechanical ventilation, in-PICU mortality rate, and percentage of
time receiving EN and PN for each patient. Bi- and multivariate analyses were
performed. Statistical significance was set at 0.05 level. Results:
Progressive increase was observed in EN use (p = .0001), median
values for which were 25% in P1 and rose to 67% by P5 in medical patients;
there was no significant difference in surgical patients. A reduction was
observed in PN use; in P1 medians were 73% and 69% for medical and surgical
patients respectively, and decreased to 0% in P5 for both groups (p =
.0001). There was significant reduction in-PICU mortality rate during P4 and
P5 among medical patients (p < .001). The risk of death was 83%
lower in patients that received EN for >50% of LOS (odds ratio, 0.17;
confidence interval, 0.066–0.412; p = .000).
Conclusions: The program motivated an increase in EN and a decrease
in PN use, mainly after implementation of NST and reduced in-PICU mortality
rate.
Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 3,
176-185 (2005)
DOI: 10.1177/0148607105029003176
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