Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter,...

Area of Science:

• Critical Care Medicine
• Clinical Nutrition
• Evidence-Based Practice

Background:

• Previous trials on nutrition therapy guidelines in critical illness lack consistent patient benefit.
• A large-scale, powered study is needed to evaluate guideline implementation's impact on patient outcomes.
• Nutrition support is crucial for critically ill patients, but optimal timing and methods remain under investigation.

Purpose of the Study:

• To assess the effect of an evidence-based feeding guideline on patient-centered outcomes in intensive care units (ICUs).
• To evaluate the impact of active guideline implementation on mortality and nutrition delivery in critically ill patients.

Main Methods:

• A multicenter, cluster-randomized, parallel-controlled trial involving 97 ICUs in China.
• Development and active implementation of an evidence-based feeding guideline using standardized educational materials and protocols.
• Primary outcome: 28-day all-cause mortality; secondary outcomes included timing of enteral nutrition (EN) and parenteral nutrition (PN) initiation.

Main Results:

• Guideline implementation led to significantly earlier EN initiation (mean difference -0.40 days, P=0.01).
• Guideline implementation resulted in delayed PN initiation (mean difference 1.06 days, P=0.001).
• No significant difference in 28-day mortality was observed between the guideline and control groups (14.2% vs. 15.2%, P=0.42).

Conclusions:

• Active implementation of an evidence-based feeding guideline accelerates EN initiation and reduces PN use in critically ill patients.
• Despite improved nutrition delivery timing, the guideline did not significantly reduce 28-day mortality in this large trial.
• Further research is warranted to optimize nutrition strategies and improve outcomes for critically ill patients.