PURPOSE: Pilot study to test a new tube feed advancement guideline designed to allow patients to acheive their goal rates faster.
METHODS: Prospective pilot study. Consecutive patients from the adult critical care units who were started on tube feedings were enrolled. Patients were excluded because of surgery or increasing pressor requirements. Pilot advancement guidelines started tube feedings at half goal rate and advanced to goal rate after 4 hours if residuals <200ml. It was determined whether patients were tolerating tube feedings at 24 and 48 hours after advancement to goal. The use of motility agents was also tracked.
RESULTS: We enrolled a total of 63 patients with tube feeding orders with the pilot tube feeding advancement guidelines. 93.7% of the patients were on the ventilator. 6.3% (4/63) of the patients were already on motility agents. Three additional patients had motility agents added after tube feedings were started. Tube feedings were tolerated at 24-hours in 95.2% (60/63) of patients and in 92.1% (58/63) of patients at 48-hours. There were no adverse events noted during the pilot study.
CONCLUSIONS: The majority of adult critically ill patients tolerate their tube feedings advanced to goal rates faster than current practice without any complications.
CLINICAL IMPLICATIONS: Advancing tube feedings in critically ill adults allow patients to meet their daily nutritional requirements sooner and subsequently facilitate better recovery.
DISCLOSURE: The following authors have nothing to disclose: Kent Clark, Karin Granger, Benjamin Mosher, John Kepros, John Armstrong
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