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Use of a nutrition support protocol to increase enteral nutrition delivery in critically ill patients
Friederike Compton1, Christian Bojarski2, Britta Siegmund2
1Friederike Compton is director of the intensive care unit and Markus van der Giet is a nephrologist in the Department of Nephrology at Charité University Medicine Berlin, Germany. Christian Bojarski is a gastroenterologist in and Britta Siegmund is the head of the Department of Gastroenterology and Infectious Diseases at Charité University Medicine Berlin. friederike.compton@charite.de.
Background:
Early enteral nutrition is recommended for patients in intensive care units, but nutrition provision is often hindered by a variety of unit-specific problems.
Objectives:
To evaluate the impact of a nutrition support protocol on nutrition prescription and delivery in the intensive care unit.
Methods:
Nutrition-related data from 73 patients receiving mechanical ventilation who were treated in an adult medical intensive care unit before introduction of an enteral nutrition support protocol were retrospectively compared with data for 87 patients admitted after implementation of the protocol.
Results:
After implementation of the protocol, enteral nutrition was started significantly earlier (P = .007) and enteral feeding goals were reached significantly faster (6 vs 10 days, P < .001) than before. Prescription of enteral nutrition on the first day of invasive mechanical ventilation increased from 38% before to 54% after (P = .03) implementation of the protocol. Prescribed and delivered nutrition doses on the first 2 days of mechanical ventilation also increased significantly (P < .001) after the protocol was implemented. Nasojejunal feeding tubes were used in 52% of patients before and 56% of patients after protocol implementation P = .63). Jejunal tubes were placed earlier after the protocol was implemented than before (median 5 vs 6.5 days), and when a jejunal tube was in place, feeding goals were reached faster (median 2 vs 3 days, P = .002).
Conclusion:
Implementing an enteral nutrition support protocol shortened the time to reach feeding goals. Jejunal feeding tubes were necessary in more than half of the patients, and with a jejunal feeding tube in place, feeding goals were reached rapidly.
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