Workshop on Nutrition Stewardship

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Date: November 23rd, 2017

Location: Hilton Congress Centre, Groenplaats, Antwerp, Belgium

Room: TBA

Program Chairs: Prof Dr Joel Starkopfs and Dr Annika Reibtam Blaser

Speakers:

Elisabeth De Waele; Brussels, Belgium
Karen Schoonheydt; Antwerp, Belgium
Joel Starkopf; Tallinn, Estonia
Annika Reintam Blaser; Tallinn, Estonia

Duration: 120 min

Pax: 40

Price: 125 EUR

Comment: This workshop can only be booked when attending the IFAD2017 meeting on Nov 24-25, 2017, at Hilton Congress Centre, Groenplaats, Antwerp, Belgium

Background:

Nutritional therapy is part of high quality care for critically ill patients. Although primarily the physician’s responsibility, it is mainly a multidisciplinary task involving nurses, doctors and dieticians. All the aspects of the treatment plan should be taken into account, resulting in a predefined road map. Each patient will have his/her own nutritional road map, which is to be expected in the era of personalized individualized care. Nutrition support needs to be adapted during the course of the disease and the patient’s stay, being in continuous interaction with clinical feedback and the changing needs over time, integrating the results of indirect calorimetry. Every critically ill patient deserves an optimal nutritional regimen, and all possible tools and interventions should be applied to make this happen. While knowledge, technical armamentarium and human competence in the field of clinical nutrition will grow, the gap between dream and reality will further narrow down to the crack where the light gets in. In this workshop we will coin the term nutritional stewardship. The background is listed below:

• Why? Absence of a clear nutritional plan may increase ICU related morbidity and mortality
• Who? All critically ill patients should receive an optimal nutrition plan, including optimization of oral intakes.
• What? A correct nutritional therapy aims at providing substances necessary to sustain cell function and life.
• Where? Different options to provide nutritional support are available, oral intake vs enteral nutrition vs parenteral vs subcutaneous delivery of nutrients in the future As the aim will be to deliver a correct amount of macro and micro nutrients, the route to be used will heavily depend on the patient.
• When? In a clinical daily setting, it would be appropriate to rely on existing guidelines and initiate feeding within 24 to 48 hours of ICU admission
• How much? Caloric and protein targeting has proven to be beneficial for critically ill patients. A possible approach would be to target caloric intake at 70 to 80% of measured energy expenditure. For proteins, a calculated dose of 1.5kg/kg ideal body weight/day is supported by ESPEN guidelines
• How to monitor? Quality control is very important and demands data acquisition and analysis.

Learning objective: This workshop will outline the basic nutritional principles that underlie the need for individualized and personalized prescription of enteral and parenteral nutrition in the critically ill. In anology to antibiotic stewardship you will learn about nutrition stewardship. In this workshop different aspects will be discussed: good nutritional stewardship focusses on ownership, screening, assessment, diagnostic procedures with indirect calorimetry, how to set up nutritional care plan, and the actual prescription and nutritional therapy as well as the follow-up of your patients.

Draft scientific program (15min presentations with 10min for general discussion)

• 2:00 PM - 2:15 PM
  Introduction: discussing the evidence (recent trials: EPANIC, PEPANIC,...) – Joel Starkopf
• 2:15 PM - 2:30 PM
  EEN: Early Enteral Nutrition (recent ESICM consensus statement) – Annika Reintam Blaser
• 2:30 PM - 2:50 PM
  Monitoring caloric needs: the role of indirect calorimetry (Techniques, How I do it,) – Elisabeth De Waele
• 2:50 PM - 3:10 PM
  How to set up nutrition team in your unit: clinical experience (incl. screening for malnutrition) – Karen Schoonheydt
• 3:10 PM - 3:25 PM
  Importance of GI symptoms in the ICU (discussing GIFT study, AGI, iSOFA) – Joel Starkopf
• 3:25 PM - 3:40 PM
  How to manage GI problems – Annika Reintam Blaser
• 3:40 PM - 3:50 PM
  General Discussion – Elisabeth De Waele; Karen Schoonheydt; Joel Starkopf; Annika Reintam Blaser;
• 3:50 PM – 4:10 PM  
  Coffee Break

Suggested reading:

1. Singer P, Berger MM, Van den Berghe G et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009;28:387-400.
2. Dodek P, Cahill NE, Heyland DK. The relationship between organizational culture and implementation of clinical practice guidelines: a narrative review. J Parenter Enteral Nutr. 2010 ;34:669-74.
3. De Waele E, Nguyen D, De Bondt K et al. The CoCoS trial: Caloric Control in Cardiac Surgery patients promotes survival, an interventional trial with retrospective control. Clin Nutr. 2017 Mar 18. pii: S0261-5614(17)30098-5. doi: 10.1016/j.clnu.2017.03.007.
4. Casaer MP, Mesotten D, Hermans G et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011 ;365:506-17.
5. Preiser JC, van Zanten AR, Berger MM et al. Metabolic and nutritional support of critically ill patients: consensus and controversies. Crit Care. 2015 Jan 29;19:35. doi: 10.1186/s13054-015-0737-8. Review.
6. Annika Reintam Blaser, Manu L. N. G. Malbrain, Joel Starkopf, Sonja Fruhwald, Stephan M. Jakob, Jan De Waele, Jan-Peter Braun, Martijn Poeze, and Claudia Spies. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems. Intensive Care Med. 2012 Mar; 38(3): 384–394. doi: 1007/s00134-011-2459-y PMCID: PMC3286505
7. Annika Reintam Blaser, Joel Starkopf, Waleed Alhazzani,Mette M. Berger, Michael P. Casaer, Adam M. Deane, Sonja Fruhwald, Michael Hiesmayr, Carole Ichai, Stephan M. Jakob, Cecilia I. Loudet, Manu L. N. G. Malbrain and ESICM Working Group on Gastrointestinal Function. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med. 2017; 43(3): 380–398. doi: 1007/s00134-016-4665-0 PMCID: PMC5323492
8. Annika Reintam Blaser, Martijn Poeze, Manu L. N. G. Malbrain, Martin Björck, Heleen M. Oudemans-van Straaten, Joel Starkopf, Gastro-Intestinal Failure Trial Group. Gastrointestinal symptoms during the first week of intensive care are associated with poor outcome: a prospective multicentre study. Intensive Care Med. 2013 May; 39(5): 899–909. Published online 2013 Jan 31. doi: 10.1007/s00134-013-2831-1. PMCID: PMC3625421

Figure courtesy: https://www.onlinembareport.com/articles/mba-spotlight-dieteticsnutrition