Nutrition support practices in South African ICUs: Results from a nationwide pilot survey

Background. Nutrition support of the critically ill can positively affect clinical outcomes. International audit data of nutrition practices in intensive care units (ICUs) suggest that inconsistent application of recommended nutrition support practices (NSPs) occurs. There are no data on NSPs in South African (SA) ICUs.  Objective. To perform a national pilot survey of NSPs in private SA adult ICUs.  Methods. A descriptive, observational, cross-sectional survey was performed among prescribers of nutrition support in private ICU facilities. Participants were targeted through non-randomised convenience sampling and invited to complete a 51-item electronic questionnaire covering ICU demographics, profile of nutrition prescribers, and nutrition assessment support, delivery and monitoring practices.  Results. Responses were received from 125 practitioners in 60% of representative private hospitals with ICU facilities, mainly general/mixed ICUs. Forty-six percent of respondents reported structured nutrition support teams and 61% reported that practices were governed by formal nutrition support protocols. Enteral nutrition was reported to be based upon published guidelines by 72% of dietitians, while parenteral nutrition decisions were reportedly based mainly on clinical judgement (43%). For both enteral and parenteral feeding practices, compliance with guidelines was inconsistent. There was a disjuncture between various NSPs as reported by dietitians and by nurses. Nurses generally appeared unaware of published nutrition guidelines.  Conclusion. Various disparities in reported nutrition practices were revealed, suggesting that the organisation and operations of teams and the implementation of protocols informed by published nutrition guidelines may not be well established in private SA ICUs.