PURPOSE: Patients in the intensive care unit frequently receive less than their caloric requirement and a better method of feeding may prevent this chronic problem.
METHODS: A prospective, randomized trial comparing the caloric deficit in a group of patients fed by rate based feeding (RBF) protocol to a similar group of patients being fed by a volume based feeding (VBF) protocol. Primary outcome: caloric deficit. Randomization was performed in block method.
RESULTS: 63 patients were randomized to either VBF protocol or RBF control. Nine patients in the protocol arm were well fed/non-candidates for the study strategy. Twenty-eight patients had low average nutrition/potential candidates with sixteen of this receiving protocol. Twelve patients never received protocol due to nursing compliance. The protocol group (n=37) received 92.9% of their caloric goal requirement for the seven days. The control group (n=20) received 80.9%. Well fed/non-candidates were defined as receiving >95% caloric goal. Excluding well fed/non-candidates, the protocol group percent goal calories received was 87.7% compared to 74.7% in the control group. Looking at the sixteen patients that received the protocol the mean goal calories received increased to 95.7% for the entire period of feeding. Upon review of calorie goal received per day, there were 82 days in which patients were potential candidates for VBF approach in the protocol arm with an average of 77.6% calories received versus 50 days in control with 61.5% calorie goal received. The protocol was implemented by the nursing staff 26 days total and on these days the mean calories received increased to 96.2%. There were no instances of feeding intolerance due to the protocol. Reviewing caloric deficit, patients receiving protocol had an average deficit of only 489.4 calories compared to an average of 2590.8 calories in the control arm.
CONCLUSION: Volume based feeding is feasible and safe. VBF nutrition better meets the caloric requirements than the standard commonly used RBF in critically ill patients on the ventilator.
CLINICAL IMPLICATIONS: Improved caloric goal received may lead to improved outcomes.
DISCLOSURE: Scott Kellie, No Financial Disclosure Information; No Product/Research Disclosure Information