Micronutrient use in critical care: survey of clinical practice
Micronutrient use in critical care: survey of clinical practice
Background & aims: micronutrients, principally vitamins and minerals, play an important role both in health and in disease. Parenteral micronutrient products are commonly prescribed for critically ill patients both in line with the terms of the product's license, and for other indications where there is an underpinning physiological rationale, or precedent, for their use but little evidence. This survey sought to understand United Kingdom (UK) prescribing practice in this area.
Methods: a 12-question survey was circulated to healthcare professionals working in UK critical care units. The survey was designed to explore several aspects of micronutrient prescribing or recommendation practice by the critical care multidisciplinary team, including indications and underpinning clinical rationale for using these products, dosing, and considerations with respect to micronutrients delivered as part of nutrition. Results were analysed, exploring indications, considerations relating to diagnoses, therapies including renal replacement therapies, and method of nutrition.
Results: 217 responses were included in the analysis, with 58% from physicians and the remaining 42% from nurses, pharmacists, dietitians and other healthcare disciplines. Vitamins were most commonly prescribed or recommended for Wernicke's encephalopathy (prescribed or recommended by 76% of respondents), treatment of refeeding syndrome (64.5%), and for patients with unknown or uncertain alcohol intake history (63.6%). These clinically suspected or confirmed indications were cited more frequently as a reason to prescribe than laboratory identified deficiency states. 20% of respondents indicated that they would prescribe or recommend parenteral vitamins for patients requiring renal replacement therapy. The practice of vitamin C prescribing was heterogeneous, including dose and indication. Trace elements were prescribed or recommended less often than vitamins, with the most frequently reported indications being for patients requiring parenteral nutrition (42.9%), biochemically confirmed deficiency states (35.9%), and for treatment of refeeding syndrome (26.3%).
Conclusions: micronutrient prescribing in ICUs in the UK is heterogeneous, with clinical scenarios where there is an evidence base or an established precedent for their use often guiding decisions to use micronutrient products. Further work to examine the potential benefits and harms on patient-oriented outcomes of micronutrient product administration should be undertaken, to facilitate their judicious and cost-effective use, with a focus on areas where they have a theoretical benefit.
critical care, critical illness, ICU, micronutrients, trace elements, vitamins
260-266
Cameron, Lynda K.
05c67d0e-7f7e-4f0d-b559-fed3d5c2af39
Lumlertgul, Nuttha
7156c119-70b8-4c88-bc38-dfa146d78086
Bear, Danielle E.
da4de451-ccba-4600-92ee-ed8bba80e288
Cooney, Enya
4cf74d9b-2b1d-4804-aa41-55c2e5a63b58
McKenzie, Catherine
ec344dee-5777-49c5-970e-6326e82c9f8c
Ostermann, Marlies
3aad45dd-7d86-40cf-80ee-d6401ebdace2
14 April 2023
Cameron, Lynda K.
05c67d0e-7f7e-4f0d-b559-fed3d5c2af39
Lumlertgul, Nuttha
7156c119-70b8-4c88-bc38-dfa146d78086
Bear, Danielle E.
da4de451-ccba-4600-92ee-ed8bba80e288
Cooney, Enya
4cf74d9b-2b1d-4804-aa41-55c2e5a63b58
McKenzie, Catherine
ec344dee-5777-49c5-970e-6326e82c9f8c
Ostermann, Marlies
3aad45dd-7d86-40cf-80ee-d6401ebdace2
Cameron, Lynda K., Lumlertgul, Nuttha, Bear, Danielle E., Cooney, Enya, McKenzie, Catherine and Ostermann, Marlies
(2023)
Micronutrient use in critical care: survey of clinical practice.
Clinical Nutrition ESPEN, 55, .
(doi:10.1016/j.clnesp.2023.03.023).
Abstract
Background & aims: micronutrients, principally vitamins and minerals, play an important role both in health and in disease. Parenteral micronutrient products are commonly prescribed for critically ill patients both in line with the terms of the product's license, and for other indications where there is an underpinning physiological rationale, or precedent, for their use but little evidence. This survey sought to understand United Kingdom (UK) prescribing practice in this area.
Methods: a 12-question survey was circulated to healthcare professionals working in UK critical care units. The survey was designed to explore several aspects of micronutrient prescribing or recommendation practice by the critical care multidisciplinary team, including indications and underpinning clinical rationale for using these products, dosing, and considerations with respect to micronutrients delivered as part of nutrition. Results were analysed, exploring indications, considerations relating to diagnoses, therapies including renal replacement therapies, and method of nutrition.
Results: 217 responses were included in the analysis, with 58% from physicians and the remaining 42% from nurses, pharmacists, dietitians and other healthcare disciplines. Vitamins were most commonly prescribed or recommended for Wernicke's encephalopathy (prescribed or recommended by 76% of respondents), treatment of refeeding syndrome (64.5%), and for patients with unknown or uncertain alcohol intake history (63.6%). These clinically suspected or confirmed indications were cited more frequently as a reason to prescribe than laboratory identified deficiency states. 20% of respondents indicated that they would prescribe or recommend parenteral vitamins for patients requiring renal replacement therapy. The practice of vitamin C prescribing was heterogeneous, including dose and indication. Trace elements were prescribed or recommended less often than vitamins, with the most frequently reported indications being for patients requiring parenteral nutrition (42.9%), biochemically confirmed deficiency states (35.9%), and for treatment of refeeding syndrome (26.3%).
Conclusions: micronutrient prescribing in ICUs in the UK is heterogeneous, with clinical scenarios where there is an evidence base or an established precedent for their use often guiding decisions to use micronutrient products. Further work to examine the potential benefits and harms on patient-oriented outcomes of micronutrient product administration should be undertaken, to facilitate their judicious and cost-effective use, with a focus on areas where they have a theoretical benefit.
Text
micronutrient survey word
- Accepted Manuscript
More information
Accepted/In Press date: 29 March 2023
e-pub ahead of print date: 3 April 2023
Published date: 14 April 2023
Additional Information:
Funding Information:
We are grateful to all colleagues who participated in this survey. We wish to thank the Intensive Care Society UK, the UK Clinical Pharmacy Association and the British Dietetic Association Critical Care Specialist Group for distributing the survey to their members. We also thank Mrs Liesl Wandrag for connecting us with the Critical Care Specialist Group of the British Dietetic Association.
The project was funded by an investigator-led grant from Baxter. The Baxter Global Scientific Review Council had sight of the manuscript prior to publication but did not influence the survey questions, methods, findings or reporting of the work.
Keywords:
critical care, critical illness, ICU, micronutrients, trace elements, vitamins
Identifiers
Local EPrints ID: 478959
URI: http://eprints.soton.ac.uk/id/eprint/478959
ISSN: 2405-4577
PURE UUID: b25328c3-66b3-4aaf-a77c-6ac0a764f10a
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Date deposited: 17 Jul 2023 16:30
Last modified: 14 Apr 2024 04:01
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Contributors
Author:
Lynda K. Cameron
Author:
Nuttha Lumlertgul
Author:
Danielle E. Bear
Author:
Enya Cooney
Author:
Catherine McKenzie
Author:
Marlies Ostermann
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