Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study

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Standard

Implementation of enteral feeding protocol in an intensive care unit : Before-and-after study. / Padar, Martin; Uusvel, Gerli; Starkopf, Liis; Starkopf, Joel; Reintam Blaser, Annika.

I: World journal of critical care medicine, Bind 6, Nr. 1, 04.02.2017, s. 56-64.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt

Harvard

Padar, M, Uusvel, G, Starkopf, L, Starkopf, J & Reintam Blaser, A 2017, 'Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study', World journal of critical care medicine, bind 6, nr. 1, s. 56-64. https://doi.org/10.5492/wjccm.v6.i1.56

APA

Padar, M., Uusvel, G., Starkopf, L., Starkopf, J., & Reintam Blaser, A. (2017). Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study. World journal of critical care medicine, 6(1), 56-64. https://doi.org/10.5492/wjccm.v6.i1.56

Vancouver

Padar M, Uusvel G, Starkopf L, Starkopf J, Reintam Blaser A. Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study. World journal of critical care medicine. 2017 feb 4;6(1):56-64. https://doi.org/10.5492/wjccm.v6.i1.56

Author

Padar, Martin ; Uusvel, Gerli ; Starkopf, Liis ; Starkopf, Joel ; Reintam Blaser, Annika. / Implementation of enteral feeding protocol in an intensive care unit : Before-and-after study. I: World journal of critical care medicine. 2017 ; Bind 6, Nr. 1. s. 56-64.

Bibtex

@article{66e5a0ba31044b39a0d0414d2828eaf8,
title = "Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study",
abstract = "AIM: To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS: An 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.RESULTS: In 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.CONCLUSION: The 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.",
keywords = "Journal Article",
author = "Martin Padar and Gerli Uusvel and Liis Starkopf and Joel Starkopf and {Reintam Blaser}, Annika",
year = "2017",
month = "2",
day = "4",
doi = "10.5492/wjccm.v6.i1.56",
language = "English",
volume = "6",
pages = "56--64",
journal = "World journal of critical care medicine",
issn = "2220-3141",
publisher = "Baishideng Publishing Group",
number = "1",

}

RIS

TY - JOUR

T1 - Implementation of enteral feeding protocol in an intensive care unit

T2 - Before-and-after study

AU - Padar, Martin

AU - Uusvel, Gerli

AU - Starkopf, Liis

AU - Starkopf, Joel

AU - Reintam Blaser, Annika

PY - 2017/2/4

Y1 - 2017/2/4

N2 - AIM: To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS: An 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.RESULTS: In 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.CONCLUSION: The 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.

AB - AIM: To determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODS: An 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.RESULTS: In 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.CONCLUSION: The 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.

KW - Journal Article

U2 - 10.5492/wjccm.v6.i1.56

DO - 10.5492/wjccm.v6.i1.56

M3 - Journal article

C2 - 28224108

VL - 6

SP - 56

EP - 64

JO - World journal of critical care medicine

JF - World journal of critical care medicine

SN - 2220-3141

IS - 1

ER -

ID: 178700183