Impact of Critical Care Registered Dietitian on Clinical Outcomes of Neurocritically Ill Patients

Background: To investigate the impact of early nutrition intervention and a critical care registered dietitian on the outcomes of neurocritically ill patients.Methods: Among neurosurgical patients admitted to the intensive care unit (ICU) in a tertiary hospital from January 2015 to December 2019, A critical care registered dietitian co-management was initiated on May 1, 2017. The primary endpoint was ICU mortality. Propensity score matching (PSM) was used to control selection bias and confounding factors.Results: In this study, 1,386 patients were included. In the overall study population, nutrition was provided to 719 (51.9%) patients under the supervision of a registered dietitian. Early nutrition was performed for 356 (25.7%) patients. In the overall study population and the PSM adjusted population, rates of early parenteral nutrition (EPN) were higher in the groups managed by a registered dietitian than in the group without a registered dietitian (both p <0.001). In the overall and PSM adjusted population, the rates of ICU mortality, 28-day mortality, and in-hospital mortality were not significant different between two groups (all p > 0.05), but the group managed by a registered dietitian had a shorter hospital stay than the group without a registered dietitian (both p <0.02). In the multivariable analysis of the overall population and PSM adjusted population, EPN showed an association with ICU mortality. Conclusions: The rate of EPN utilization increased after the implementation of co-management with a critical care registered dietitian, and the use of EPN was associated with lower ICU mortality in neurocritically ill patients.