Malnutrition in the Intensive care unit (ICU) is associated with increased morbidity, mortality, increased length of ICU stay, prolonged mechanical ventilation, higher rates of infection, and poor wound healing. We intend to determine if implementing an evidence based feeding protocol will improve feeding practices in the ICU.
In a tertiary care teaching hospital we evaluated the enteral feeding (EF) practice in the ICU during a four month period. Patients over 18 years old with an expected ICU stay of over 48 hours who had no contraindication for EF were enrolled. We implemented an EF protocol which was initiated by the physician at the time of admission and followed through by dietitians and nursing staff. The EF practice in the post protocol group was compared to the pre protocol group using a two tailed t-test. Secondary out comes include identifying physician compliance in following the implemented EF protocol.
Compared to the pre protocol group (n = 46) the patients in the post protocol group (n = 41) showed statistically significant improvement in: Time to initiate feeding (0.54 v. 2.23 days; p = < 0.001); Days fed (9.76 v. 9.46 days; p = 0.03); Days goal feeding achieved (4.65 v. 5.48 days; p = 0.02); Total energy delivered (1127 v. 1031 kcal; p = 0.03); Total protein delivered (54.3 v. 45.2 grams; p = < 0.001). In the post protocol phase the physician compliance in adhering to the protocol was 68.5%.
In our practice significant delay in initiating nutritional support in the ICU was identified. By implementing an enteral feeding protocol, activated by the physician at the time of admission and followed through by the nursing and dietitians we were able to demonstrate a statistically significant improvements in the nutritional support.
Nutritional practice in the ICU can be improved by introducing protocols build on evidence based guidelines.
Mahesh Bandara, No Financial Disclosure Information; No Product/Research Disclosure Information