Survey on Nutrition in Neurological Intensive Care Units (SONNIC)—A Cross-Sectional Survey among German-Speaking Neurointensivists on Medical Nutritional Therapy

Gehri, Leon; Schmidbauer, Moritz L.; Putz, Timon; Ratkovic, Luka; Maskos, Andreas; Zeisberger, Cedric; Zibold, Julia; Dimitriadis, Konstantinos (2024): Survey on Nutrition in Neurological Intensive Care Units (SONNIC)—A Cross-Sectional Survey among German-Speaking Neurointensivists on Medical Nutritional Therapy. Journal of Clinical Medicine, 13 (2): 447. ISSN 2077-0383

Abstract

Survey on Nutrition in Neurological Intensive Care Units (SONNIC)—A Cross-Sectional Survey among German-Speaking Neurointensivists on Medical Nutritional Therapy Leon Gehri Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany Moritz L. Schmidbauer Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany http://orcid.org/0000-0001-9553-9911 Timon Putz Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany Luka Ratkovic Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany Andreas Maskos Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany Cedric Zeisberger Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany Julia Zibold Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany http://orcid.org/0000-0002-7768-8443 Konstantinos Dimitriadis Department of Neurology, LMU University Hospital, Ludwig-Maximilians-University Munich, 81377 Munich, Germany http://orcid.org/0000-0003-0417-2267 on behalf of the IGNITE Study Group

Medical nutritional therapy (MNT) in neurointensive care units (NICUs) is both particularly relevant and challenging due to prolonged analgosedation, immobilization, disorders of consciousness, and the high prevalence of dysphagia. Moreover, current guideline recommendations predominantly address the general intensive care unit (ICU) population, overlooking specific characteristics of neurological patients. We, therefore, conducted a web-based, cross-sectional survey for German-speaking neurointensivists mapping the clinical practices of MNT on NICUs to identify research gaps and common grounds for future clinical trials. A total of 25.9% (56/216) NICU representatives responded to our questionnaire. A total of 78.2% (43/55) were neurologist and 63% (34/54) held a leadership role. Overall, 80.4% (41/51) had established a standard operating procedure (SOP), largely based on the DGEM-Guideline (53.7%; 22/41), followed by the ESPEN-Guideline (14.6%; 6/41). Upon admission, 36% (18/50) conducted a risk stratification, with 83.3% primarily relying on past medical history (15/18) and clinical gestalt (15/18). Energy expenditure (EE) was measured or calculated by 75% (36/48), with 72.2% (26/36) using pragmatic weight-based equations. Indirect calorimetry was used by 19.4% (7/36). A total of 83.3% (30/36) used the patient’s serum glucose level as the primary biomarker to monitor metabolic tolerance. SOPs regarding ICU-Acquired Weakness (ICUAW) were found in 8.9% (4/45) of respondents. Overall, guideline adherence was 47%. In summary, this is, to the best of our knowledge, the first study systematically describing the currently applied concepts of MNT on NICUs. The data reveal great variations in the implementation of guideline recommendations, indicating the need for further research and tailored approaches to optimize nutritional therapy in neurointensive care settings.
Medical nutritional therapy (MNT) in neurointensive care units (NICUs) is both particularly relevant and challenging due to prolonged analgosedation, immobilization, disorders of consciousness, and the high prevalence of dysphagia. Moreover, current guideline recommendations predominantly address the general intensive care unit (ICU) population, overlooking specific characteristics of neurological patients. We, therefore, conducted a web-based, cross-sectional survey for German-speaking neurointensivists mapping the clinical practices of MNT on NICUs to identify research gaps and common grounds for future clinical trials. A total of 25.9% (56/216) NICU representatives responded to our questionnaire. A total of 78.2% (43/55) were neurologist and 63% (34/54) held a leadership role. Overall, 80.4% (41/51) had established a standard operating procedure (SOP), largely based on the DGEM-Guideline (53.7%; 22/41), followed by the ESPEN-Guideline (14.6%; 6/41). Upon admission, 36% (18/50) conducted a risk stratification, with 83.3% primarily relying on past medical history (15/18) and clinical gestalt (15/18). Energy expenditure (EE) was measured or calculated by 75% (36/48), with 72.2% (26/36) using pragmatic weight-based equations. Indirect calorimetry was used by 19.4% (7/36). A total of 83.3% (30/36) used the patient’s serum glucose level as the primary biomarker to monitor metabolic tolerance. SOPs regarding ICU-Acquired Weakness (ICUAW) were found in 8.9% (4/45) of respondents. Overall, guideline adherence was 47%. In summary, this is, to the best of our knowledge, the first study systematically describing the currently applied concepts of MNT on NICUs. The data reveal great variations in the implementation of guideline recommendations, indicating the need for further research and tailored approaches to optimize nutritional therapy in neurointensive care settings.

• Dokumententyp: Artikel (Klinikum der LMU)
• Organisationseinheit (Fakultäten): 07 Medizin > Klinikum der LMU München > Neurologische Klinik und Poliklinik mit Friedrich-Baur-Institut
• DFG-Fachsystematik der Wissenschaftsbereiche: Lebenswissenschaften
• DFG: Gefördert durch die Deutsche Forschungsgemeinschaft (DFG) - 491502892