PURPOSE: Evidence-based enteral nutrition (EN) protocols have been shown to optimise nutrition delivery in intensive care units and improve clinical outcomes. This study aims to assess the impact of such a protocol on feeding practices in our medical intensive care unit (MICU).
METHODS: An audit of MICU patients before and after the implementation of an EN protocol, was conducted. The inclusion criteria were 1) mechanically ventilated within 48 hours of admission, and (2) stayed in MICU for at least 3 days. Apache II scores, amount of nutrition delivered, ventilator days , ICU length of stay and 28-day mortality were recorded.
RESULTS: The pre-protocol group was obtained from September to October 2009 (24 patients) and the post-protocol group between November 2010 and January 2011 (32 patients). The pre and post protocol groups were matched for age (mean 70.3 years, SD 12.4 vs 68.3, SD 13.8) and Apache II scores (mean 25.9,SD 7.4 vs 23.1, SD 5.4). After protocol implementation, the number of patients who reached target calories within 5 days doubled from 33% to 67%. There was an observed reduction in ventilator days (mean 9.1 days, SD 8.5 vs 5.9 days, SD 3.1), length of ICU stay (mean 10 days, SD 8.3 vs 7 days, SD 3.4) and 28-day mortality (50% vs 21%) was observed (although not statistically significant).
CONCLUSIONS: The EN protocol doubled the number of patients achieving nutrition goals in the MICU within a 5-day period. There trend towards reduction in ventilator days, ICU length of stay and mortality needs to be validated by larger studies
CLINICAL IMPLICATIONS: Feeding protocols have a definite role in the ICU setting, especially with regard to reaching nutritional goals
DISCLOSURE: The following authors have nothing to disclose: Vijo Poulose, Izabella Kerner
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