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To the Editor: Although providing early nutritional support of patients in the intensive care unit (ICU) is a strategy that may significantly reduce mortality, its implementation is far from complete. In their randomized controlled trial, Dr Doig and colleagues¹ successfully developed and implemented a complex evidence-based nutrition guideline promoting early feeding, using a multifaceted practice change strategy. All hospitals implemented the nutrition guideline, resulting in a significant increase in the number of patients who received nutritional support during ICU stay and who were fed early (within 24 hours of ICU admission).

However, whether practice will continue to remain good after the initial guideline implementation remains uncertain. This question was not tested in the study by Doig et al, since the cluster randomized trial did not assess nutritional support beyond the 20-week study period. During the recruitment phase, dietitian site investigators may have been especially successful in motivating their colleagues to . . . [Full Text of this Article]

Marcus J. Schultz, MD, PhD
m.j.schultz@amc.uva.nl
Department of Intensive Care Medicine
Academic Medical Center
University of Amsterdam
Amsterdam, the Netherlands

Peter Spronk, MD
Department of Intensive Care Medicine
Gelre Hospital
Apeldoorn, the Netherlands

Robert Tepaske, MD, PhD
Department of Intensive Care Medicine
Academic Medical Center
University of Amsterdam
Amsterdam, the Netherlands

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