Nutrition practices in Australia and New Zealand in response to evolving evidence: Results of three point-prevalence audits

L S Chapple; A Neuts; S N O'Connor; P Williams; S Hurford; P J Young; N E Hammond; S Knowles; M J Chapman; S Peake; TARGET Investigators, The George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group

doi:10.1016/j.aucc.2024.07.079

Nutrition practices in Australia and New Zealand in response to evolving evidence: Results of three point-prevalence audits

Aust Crit Care. 2024 Aug 22:S1036-7314(24)00208-X. doi: 10.1016/j.aucc.2024.07.079. Online ahead of print.

Affiliations

¹ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: [email protected].
² Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Department of Anesthesiology and Intensive Care Medicine, Jessa Hospital, Hasselt, Belgium.
³ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia.
⁴ Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.
⁵ Medical Research Institute of New Zealand, Wellington, New Zealand.
⁶ Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Medical Research Institute of New Zealand, Wellington, New Zealand; Intensive Care Unit, Wellington Hospital, Wellington, New Zealand; Department of Critical Care, University of Melbourne, Melbourne, Victoria, Australia.
⁷ Critical Care Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Newtown, NSW, Australia; Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.
⁸ Critical Care Program, The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Newtown, NSW, Australia.
⁹ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia; Adelaide Medical School, The University of Adelaide, South Australia, Australia; Centre of Research Excellence in Nutritional Physiology, The University of Adelaide, South Australia, Australia; Australian and New Zealand Intensive Care Research Centre, School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.

PMID: 39179491
DOI: 10.1016/j.aucc.2024.07.079

Abstract

Background: The Augmented versus Routine Approach to Giving Energy Trial (TARGET) was a 4000-patient trial in which augmented enteral calorie dose did not influence outcomes.

Aim: We aimed to quantify practice change following TARGET.

Methods: Three single-day, prospective, multicentre, point-prevalence audits of adult patients receiving enteral nutrition (EN) in participating Australian and New Zealand intensive care units at 10:00 AM were conducted: (i) 2010 (before conducting TARGET); (ii) 2018 (immediately before publishing TARGET results); and (iii) 2020 (2 years after TARGET publication). Data included baseline characteristics, clinical outcomes, and nutrition data. Data are n (%), mean ± standard deviation, or median [interquartile range]. Differences in enteral calorie prescription between 2018 and 2020 were compared using the Mann-Whitney test.

Results: The percentage of patients receiving EN (2010 42%, 2018 38%, 2020 33%; P = 0.012) and the prescription of calorie-dense EN formula (≥1.5 kcal/ml) (2010 33%, 2018 24%, 2020 23%; P = 0.038) decreased over time. However, when comparing prepublication and postpublication (2018-2020), calorie dose and calorie density were similar: 22.9 ± 8.6 versus 23.4 ± 12.8 kcal/kg/day (P = 0.816) and <1.5 kcal/ml: 76 versus 77% (P = 0.650), respectively.

Conclusion: In Australian and New Zealand intensive care units, enteral calorie dose and calorie density of prescribed EN were similar before TARGET publication and 2 years later.

Keywords: Calorie dose; Calorie prescription; Critical care; Enteral nutrition; Practice change.