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Related Experiment Video

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Use of a Central Venous Line for Fluids, Drugs and Nutrient Administration in a Mouse Model of Critical Illness
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Volume-Based Feeding in the Critically Ill Patient.

Stephen A McClave1, Mohamed A Saad2, Mark Esterle2

  • 1Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky samcclave@louisville.edu.

JPEN. Journal of Parenteral and Enteral Nutrition
|June 20, 2014
PubMed
Summary

Volume-based feeding (VBF) improves caloric delivery in critically ill patients compared to rate-based feeding (RBF). This feeding strategy is safe and helps meet nutritional requirements more effectively.

Keywords:
enteral nutritionrate-based feedingvolume-based feeding

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Area of Science:

  • Critical Care Medicine
  • Nutritional Support
  • Clinical Nutrition

Background:

  • Critically ill patients often receive inadequate enteral nutrition (EN).
  • Standard rate-based feeding (RBF) may lead to underfeeding due to delivery interruptions.
  • Volume-based feeding (VBF) is a protocol designed to adjust EN rates to compensate for interruptions.

Purpose of the Study:

  • To compare the efficacy and safety of a VBF protocol versus an RBF protocol in critically ill patients requiring mechanical ventilation.
  • To determine if VBF improves caloric delivery compared to RBF.

Main Methods:

  • A single-center, prospective randomized study (3:1 VBF/RBF) was conducted.
  • Critically ill patients on mechanical ventilation receiving EN for ≥ 3 days were enrolled.
  • Feeding strategies were implemented once the goal rate was achieved, with VBF adjusting hourly rates based on total volume and RBF using a constant hourly rate.

Main Results:

  • The VBF group (n=37) received 92.9% of goal calories, significantly more than the RBF group (n=20) which received 80.9% (P=.01).
  • Mean caloric deficit was lower in the VBF group (-776.0 kcal) compared to the RBF group (-1933.8 kcal) (P=.01).
  • On days with feeding interruptions, VBF patients received 77.6% of goal calories versus 61.5% for RBF patients (P=.001), with no increased intolerance.

Conclusions:

  • Volume-based feeding (VBF) is a safe strategy for critically ill patients.
  • VBF significantly improves the delivery of enteral nutrition compared to traditional rate-based feeding (RBF).
  • VBF helps critical care patients better meet their caloric requirements.