Upon completion of the course

• The candidate would be able to correctly identify malnutrition and the at-risk patients.
• Would be able to evaluate the nutritional needs in critically ill patients.
• Would help in providing training to other staff like junior dietitians/nurses/pharmacists and other technical or parallel branches.
• Would be able to ensure timely delivery of correct nutrition and nutritional interventions.
• Will understand the professionalism in the delivery of nutritional care.
• Will develop interpersonal skills, patient communication skills and perform quality nutrition care.
• Prepare diet charts for enteral or oral nutrition support.
• Understand all aspects of parenteral nutrition.
• Understand access, routes, equipment, and modes of delivery of nutrition.
• Learn to provide evidence based nutritional interventions for critically ill patients with various diseases, co morbidities and interventions.

Minimum requirements to be recognized as a fellowship training center for this course:

1. Centers who have accreditation to run the Indian Fellowship in critical care medicine (IFCCM) course.
2. Centre should have at least 1 clinical nutrition specialist (salaried with the organization) on a full-time basis with a minimum of Post-Graduation in Nutrition and Dietetics, [i.e. M.Sc.] from any of the UGC approved Universities in India.
3. Centre should have at least 1 medical doctor of any specialty with an established interest in nutrition support who would be designated as the medical supervisor of a formal nutrition support team.
4. Centre should have nutrition support team with mandatory multidisciplinary rounds in the ICU.
5. The center should demonstrate continued excellence in the field of critical care nutrition by any of the following.
   a. Team member who has delivered lectures in nutrition at a state level, national or international conference.
   b. Published at least 1 research paper in the field of nutrition in an indexed.
   c. Journal (PubMed, Directory of open access journals-DOAJ, Index Copernicus).
   d. Written at least one chapter or a book on nutrition.
   e. Once accredited, the IFCCM teacher and the Head of the department of clinical dietetics remain as co-faculty for the course.
6. The center should facilitate digital access to trainees of major societies websites to enable trainees to keep up with ongoing literature. Suggested sites include Indian Society of Critical Care Medicine, Indian Society for Parenteral and Enteral Nutrition, American Society for Parenteral and enteral Nutrition, European society for Parenteral and Enteral Nutrition and Metabolism with direct links to their journals and unlimited free access.

The center must be accredited by a team of two inspectors- 1 from ISPEN and 1 from ISCCM decided by the respective societies.

Minimum requirements to be recognized as a teacher for this course. (can be intensivist/ or critical care dietitian)

   1. Should have delivered lectures in nutrition at a state level, national or international conference of the ISCCM or the ISPEN
   2. Published at least 1 research paper in the field of nutrition in an indexed journal (PubMed, Directory of open access journals-DOAJ, Index Copernicus)
   3. Written at least one chapter or a book on nutrition endorsed by the ISCCM or ISPEN.

Once accredited, the designated teacher and the Head of the department of clinical dietetics remain as co-faculty for the course.

Entry Requirements:

• Minimum Criteria is a Post-Graduation in Nutrition and Dietetics, [i.e., M.Sc.] from any of the UGC approved Universities in India. (candidates who have pursued degree in distance mode will not be considered).
• Practicing Dietitians
• Graduate in Nutrition and Dietetics, [i.e., B.Sc.] from Foreign Universities, upon the decision from the Board of Fellowship Study.
• Registered Life Membership in ISPEN.
• Associate Life Membership or life members in ISCCM.
• Medical Graduates in allopathic branches of medicine with valid medical license to practice medicine in India.

Entry Criteria:

Upon the interview conducted by the appointed Faculty and hospital human resources head or designate, opted by the candidate, where they want to pursue the Fellowship.

Duration of the Program:

1 year

In the case that there are multiple specialty ICU facilities (like Neuro -ICU, Surgical-ICU etc.) it is essential that candidates are given to rotate in each of these ICUS as per the feasibility.

Mode of Study:

Full time

Fellowship Fee:

INR 14160/- (Rupees fourteen thousand one hundred and sixty)

Stipend:

The candidates will be paid as per norms of the hospital.

All the Fellows are expected to have a logbook in a prescribed format, in which the cases seen and procedures attended/ performed shall be noted (Minimum of 3 cases per week), and to get signed by the designated faculty. Faculty should be the in-charge of monitoring and reviewing the logbook and provide continuous feedback to the trainee.

Click here to download log book format : Download

MODULE 1- IMPORTANCE OF CRITICAL CARE NUTRITION SUPPORT

• Malnutrition- unrecognized problem in hospitalized patients
• Why feed critically ill patient
• Which patients should be fed?
a. Metabolic response to critical illness
b. Role of nutrients during feeding critically ill patient

Learning Objectives:

• Understanding the meaning of critical illness.
• Metabolic and nutritional consequences of critical illness.
• Recognizing malnutrition in critically ill.

MODULE 2- NUTRITION SCREENING AND ASSESSMENT IN ICU

• Anthropometry
• Biochemistry
• Clinical
• Diet History
• Monitoring A Patient in ICU with Nutrition Focused Physical Examination
• GLIM Criteria for identifying malnutrition.
• How to assess nutritional status in the ICU? / Use of indirect calorimetry,
• Body composition and methods to assess.
• Risk Assessment and nutrition screening and assessment tools

Learning Objectives:

• Being able to identify malnutrition among hospitalized patients.
• Understanding nutritional screening – meaning, goals, components, outcome and importance.
• Basic knowledge about the various screening tools that are available.
• Being able to perform nutritional assessment – record anthropometric measurements, interpret the anthropometric and biochemical readings, being able to identify the physical signs of various deficiencies.
• Being able to administer the most commonly tool used for nutritional assessment.
• Apply body composition analysis.

MODULE 3 - ENTERAL NUTRITION (EN)

• Indications and Contraindications of EN
• Who Needs EN Support
• Routes of Enteral Feeding
a. How to insert Nasogastric and nasojejunal tube
b. How to measure gastric residual volume.
   o Implementing EN
   o Calculation Of Energy, protein & other nutrients.
   o Choice of formulations
   o How to get the EN Prepared Under Aseptic conditions.
   o Writing EN Orders
   o How to Feed?
   o Monitoring of EN Support
   o Aspiration & Refeeding Syndrome
   o International and National Guidelines

MODULE 4 - PARENTERAL NUTRITION (PN)

• Indications & Contraindications for PN
• Nutritional Assessment
• Venous Access
• Parenteral Nutrition Formulas – Types & Constituents
• Administering PN
• Complications Associated with PN
• Monitoring and discontinuation of PN
• Home PN Support
• National and International Guidelines
• Components of a PN feeding protocol

MODULE 5- PERIOPERATIVE NUTRITION

5.1 Pre- and Post-Operative Critically Ill

• Modification of Nutrients- Nutritional Support
• Energy
• Protein- Reasons for Increased Protein Demand
• Fluid
• Vitamins And Trace elements.
• Parenteral Feeding for Post-Operative Patients
• Enteral Feeding- Modification in Different Kinds of Surgery

5.2 An Overview of Critical Illness, Its Consequences on Organ Function, Treatments, and Effects on Nutrient Metabolism

• Intestinal Failure and The Short Gut Syndrome
• Gastrointestinal Fistula
• Nutrition Intervention in Acute/ Chronic Pancreatitis

5.3 Nutritional Intervention in Hepatic Failure

• Acute Liver Failure
• Chronic Liver Failure
• Role of Liver Transplant and Association with Nutritional Status

5.4 Nutritional Intervention in Renal Disease

• Acute Kidney Injury
• Chronic kidney disease- With And Without Dialysis

5.5 Nutritional Intervention in Respiratory Failure

• Acute Respiratory Failure
• Chronic Respiratory Failure

Module 6 Nutritional Support in Burns & Trauma

• Nutrition Support in Trauma
• Absorption, Metabolism of Micro and Macro Nutrients
• Nutritional Status and Body Composition of Burn, Trauma
• Criteria for Implementation of Nutrition Support
• Principles of Prescription (Route and Amount)
• Composition of Nutrition Support Formulas for Burn, Trauma
• Management of Enteral Nutrition
• Management of Parenteral Nutrition
• Post ICU Management
• Case Studies in Burn, Trauma
• Nutrition in Wound Healing

Module 7 Nutrition Support in Sepsis

Module 8 Nutrition Support in Neurological Conditions

Module 9 Nutrition in Special Conditions- Mechanical Ventilation, ECMO, CRRT, prone position

Module 10 Nutrition Intervention in The Obese Patient

Module 11 Research Acumen

• Data collection, Analysis, Research Paper writing skills for publication

Mini project: To collect data and work towards publications.

Registered candidates should do a project not limited to, but at minimum a case series or an observationalstudy or a prospective retrospective or interventional study during their course which must presented in a regional or national conference of critical care or Nutrition. This is a mandatory requirement to qualify for the exit exam.

If the candidate does not clear the exit exam, then the candidate can attempt the exam again with the next scheduled batch exam. The candidate does not need to repeat the fellowship term again in this case.

Attendance Requirements and Leave Policy:

48 hours per week and the leave policy would be as per the institutional leave policy.

Exit Exam:

Upon the successful completion of the Fellowship Program, the candidate will have to take an exit examination, comprising of Theory and Practical evaluation. The Examination Centre will be announced in due course.

• Theory: Multiple Choice Questions
• Practical: Viva, and Bedside Evaluation- by External Examiners, as delegated by ISPEN and ISCCM

Teaching Methodology:

• Bedside Lectures
• Classroom Lectures
• Online Lectures- Zoom or any other media.
• Webinars
• Presentations
• Group discussion of case studies
• Weekly reading assignments

Award of Fellowship:

Upon the successful completion of Fellowship coursework and Final Exit exam, the candidate will be announced to have cleared the Fellowship Critical Care Nutrition (FCCN). The Fellowship will be conferred to the candidate in the National Conference of ISCCM, in the presence of Board of Fellowship Program and representation from both the societies.