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Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study.
| Content Provider | Europe PMC |
|---|---|
| Author | Padar, Martin Uusvel, Gerli Starkopf, Liis Starkopf, Joel Reintam Blaser, Annika |
| Copyright Year | 2017 |
| Abstract | AIMTo determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODSAn uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population Registry and the hospital’s Infection Control Service. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed.RESULTSIn total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group (86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospital-acquired infections, length of ICU stay and ICU, 30- and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d (P = 0.026) and 120-d (P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently (P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally (P = 0.049) and a lower cumulative amount of parenterally (P < 0.001) provided calories by day 7, with an overall reduction in caloric provision (P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding (total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After (P < 0.001). Inclusion in the Before group, previous abdominal surgery, intra-abdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSIONThe use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension. |
| Related Links | https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC5295170&blobtype=pdf |
| Journal | World Journal of Critical Care Medicine [World J Crit Care Med] |
| Volume Number | 6 |
| DOI | 10.5492/wjccm.v6.i1.56 |
| PubMed Central reference number | PMC5295170 |
| Issue Number | 1 |
| PubMed reference number | 28224108 |
| e-ISSN | 22203141 |
| Language | English |
| Publisher | Baishideng Publishing Group Inc |
| Publisher Date | 2017-02-04 |
| Access Restriction | Open |
| Rights License | This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved. |
| Subject Keyword | Gastrointestinal symptoms Underfeeding Nutrition protocol Feeding protocol Enteral feeding Enteral nutrition Parenteral nutrition Critical care |
| Content Type | Text |
| Resource Type | Article |
| Subject | Critical Care and Intensive Care Medicine |
