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Implementing a physician-driven feeding protocol is not sufficient to achieve adequate caloric and protein delivery
Ismael Touré1, Guillaume Maitre1, Laurence Boillat1
1Paediatric Intensive Care Unit, Service of Paediatrics, Women-Mother-Children Department, Lausanne University and Lausanne University Hospital, Rue du Bugnon 21, 1011 Lausanne, Switzerland.
Insights
Implementing a physician-driven enteral feeding protocol in a pediatric intensive care unit (PICU) did not improve daily caloric and protein delivery for critically ill children. Further research is needed to enhance nutritional support and patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Clinical Nutrition
- Evidence-Based Practice
Background:
- Optimal daily caloric and protein intake is vital for critically ill children.
- The effectiveness of enteral feeding protocols in enhancing nutritional delivery in this population is debated.
- This study evaluated a new enteral feeding protocol in a pediatric intensive care unit (PICU).
Purpose of the Study:
- To determine if an enteral feeding protocol improves daily caloric and protein delivery by day 5 in a PICU.
- To assess the accuracy of medical prescriptions for nutritional intake.
- To analyze the impact of the protocol on patient outcomes.
Main Methods:
- Retrospective comparison of daily caloric and protein intake before and after protocol implementation.
- Inclusion criteria: PICU patients requiring enteral feeding for at least 5 days.
- Data collected included prescribed vs. actual intake and patient characteristics.
Main Results:
- No significant difference in caloric and protein intake was observed before and after protocol introduction.
- Prescribed caloric targets were consistently lower than theoretical needs.
- Patients receiving >100% of target intake showed reduced PICU length of stay and ventilation duration.
Conclusions:
- A physician-driven enteral feeding protocol did not increase caloric or protein delivery in this PICU cohort.
- Alternative strategies are required to optimize nutritional support and improve outcomes for critically ill children.
- Further investigation into nutritional delivery methods and their impact on patient recovery is warranted.
Background And Aims:
Daily caloric and protein intake is crucial for the management of critically ill children. The benefit of feeding protocols in improving daily nutritional intake in children remains controversial. This study aimed to assess whether the introduction of an enteral feeding protocol in a paediatric intensive care unit (PICU) improves daily caloric and protein delivery on day 5 after admission and the accuracy of the medical prescription.
Methods:
Children admitted to our PICU for a minimum of 5 days who received enteral feeding were included. Daily caloric and protein intake were recorded and retrospectively compared before and after the introduction of the feeding protocol.
Results:
Caloric and protein intake was similar before and after introduction of the feeding protocol. The prescribed caloric target was significantly lower than the theoretical target. The children who received less than 50% of the caloric and protein targets were significantly heavier and taller than those who received more than 50%; the patients who received more than 100% of the caloric and protein aims on day 5 after admission had a decreased PICU length of stay and decreased duration of invasive ventilation.
Conclusion:
The introduction of a physician-driven feeding protocol was not associated with an increase in the daily caloric or protein intake in our cohort. Other methods of improving nutritional delivery and patient outcomes need to be explored.
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