Perceived barriers to effective enteral and parenteral nutrition in pediatric intensive care units in Ecuador: a multicenter survey study.

Aims: To identify the main barriers perceived by pediatric intensive care healthcare professionals in delivering enteral and parenteral nutrition to critically ill children in Ecuador. Methods: An online cross-sectional survey was sent electronically from May 2020 to July 2020 to PICU intensivists, pediatricians, nurses, and dieticians across Ecuador. The questionnaire consisted of 27 questions on the barriers to enteral nutrition (EN) and 10 questions on the barriers to parenteral nutrition (PN). Respondents were asked to rate each barrier based on a 7-point Likert scale that ranged from 0 = “it is not a barrier at all” to 6 = “it has a great influence as a barrier”. Each barrier was classified into three categories according to the Likert scale score: no barrier (0), moderate barrier (1-3), and important barrier (4-6). Results: A total of 119 responses from 16 hospitals were obtained. 34% of respondents were pediatricians, 21% pediatric intensivists, 39% nurses, and 6% dieticians. The top 5 perceived barriers for EN were: 1) Feeding being held too far in advance of procedures or operating room visits, 2) Not enough time dedicated to education and training, 3) No or not enough dietician coverage during evenings, weekends, and holidays 4) Dietician not routinely present on weekday patient rounds, 5) Lack of familiarity with current guidelines for nutrition. For PN the top three perceived barriers were: 1) Waiting for physician to place a central venous catheter and then request and review X-ray to confirm its correct placement, 2) There is no PN protocol in place or it is not applied, 3) There is no catheter or catheter lumen available for PN purposes only. Conclusions: Our study shows that many perceived barriers to EN in Ecuadorian PICUs are like those found internationally. Barriers to the implementation of PN were also evaluated, finding organizational problems to be one of the main limitations. Most of the identified barriers can be overcome through practical strategies such as the development of specific protocols for enteral and parenteral nutrition and the conformation of multidisciplinary teams. It is essential to implement continuous training programs in nutrition for all health personnel in charge of critically ill pediatric patients.