FCCN

The presence of optimal evidenced-based nutritional intervention and a nutrition support team have demonstrated favorable outcomes. Both critical care doctors and dietitians do not have critical care nutrition in their core curriculum which will require a formal internship/ fellowship in an institute that conforms to high standards in critical care nutrition. This will help in fostering a group of highly specialized critical care nutrition practitioners who would help in changing outcomes and impart quality nutrition care.

Thus, there is a need to facilitate a collaborative and mutually beneficial fellowship and certificate program which will help both societies – ISPEN and ISCCM

To enhance the knowledge on latest practice guidelines in critical care nutrition for better patient outcomes.

• Encouraging continued professional growth in the practice of nutrition support.
• Establishing and measuring the level of knowledge required for certification of a nutrition support practitioner.
• Providing a standard of minimum knowledge deemed appropriate for practice of nutrition therapy leading to a long-term interest.

To create a pool of formally trained Clinical Nutrition professionals, both medical doctors and Dietitians, who can effectively manage nutrition interventions for all types of patient categories. This will enhance nutrition practice with following course objectives:

• 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.

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.
   1. Team member who has delivered lectures in nutrition at a state level, national or international conference.
   2. Published at least 1 research paper in the field of nutrition in an indexed.
   3. Journal (PubMed, Directory of open access journals-DOAJ, Index Copernicus).
   4. Written at least one chapter or a book on nutrition.
   5. 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.

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.

• 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.

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.

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.

Full time

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

Exit Exam:

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

Award of Fellowship:

• Malnutrition- unrecognized problem in hospitalized patients
• Why feed critically ill patient
• Which patients should be fed?

1. Metabolic response to critical illness
2. 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.

• 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.

• Indications and Contraindications of EN
• Who Needs EN Support
• Routes of Enteral Feeding

1. How to insert Nasogastric and nasojejunal tube
2. How to measure gastric residual volume.
   • Implementing EN
   • Calculation Of Energy, protein & other nutrients.
   • Choice of formulations
   • How to get the EN Prepared Under Aseptic conditions.
   • Writing EN Orders
   • How to Feed?
   • Monitoring of EN Support
   • Aspiration & Refeeding Syndrome
   • International and National Guidelines

• 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

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

• 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

• 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.