Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study.

Enteral nutrition (EN) feeding protocol was proposed to have positive impact on critically ill patients. However, current studies showed conflicting results. The present study aimed to investigate whether enteral feeding protocol was able to improve clinical outcomes in critically ill patients.A before (stage 1) and after (stage 2) interventional study was performed in 10 tertiary care hospitals. All patients expected to stay in the intensive care unit (ICU) for over three days were potentially eligible. Clinical outcomes such as 28-day mortality, ICU length of stay, duration of mechanical ventilation (MV), and nosocomial infection were compared between the two stages.A total of 410 patients were enrolled during the study period, including 236 in stage 1 and 174 in stage 2. EN feeding protocol was able to increase the proportion of EN in day 2 (41.8±22.3 vs. 50.0±28.3%; p = 0.006) and day 6 (70.3±25.2 vs. 77.6±25.8%; p = 0.006). EN percentages tended to be higher in stage 1 than that in stage 2 on other days, but statistical significance was not reached. There was no difference in 28-day mortality between stage 1 and 2 (0.14 vs. 0.14; p = 0.984). Implementation of EN feeding protocol marginally reduced ICU length of stay (19.44±18.48 vs. 16.29±16.19 days; p = 0.077). There was no difference in the duration of MV between stage a and stage 2 (14.24±14.49 vs. 14.51±17.55 days; p = 0.877).The study found that the EN feeding protocol was able to increase the proportion of EN feeding, but failed to reduce 28-day mortality, incidence of nosocomial infection or duration of MV

Comparisons of the percentage (%) of estimated energy goal reached from day 1 to day 7.

<p>Comparisons of the percentage (%) of estimated energy goal reached from day 1 to day 7.</p

Comparisons of baseline characteristics of subjects enrolled in the two stages (categorical variables).

<p>Comparisons of baseline characteristics of subjects enrolled in the two stages (categorical variables).</p

Comparisons of outcome variables of stage one versus stage two.

<p>Comparisons of outcome variables of stage one versus stage two.</p

Enteral nutrition tolerance score.

<p>Enteral nutrition tolerance score.</p

Missing pattern of some important variables.

<p>Missing pattern of some important variables.</p

Enteral feeding algorithm.

<p>Before EN initiation, Hemodynamic should be stabilized with MAP>65 mmHg and lactate<4 mmol/l, or vasopressor dose was decreasing. GI function was then evaluated with the AGI staging system. For pateints with AGI of I, EN could be started at 25 ml/h. For patients with AGI II-III, predigested EN could be started at 10–15 ml/h. EN was withheld for those with AGI IV. If patients were at high risk of malnutrition, parenteral nutrition (PN) should started.</p

Protocols for the management of adverse events.

<p>EN was discontinued if persistent abdominal pain occurred. Physical examination and abdominal computed tomography would be ordered. If there was bowel obstruction or ischemia, EN would be discontinued. Diarrhea could be caused by enteral feeding, specific diseases and drugs. If clostridium difficile (CD) infection was identified, the patient should be treated with metronidazole or vancomycin. If the patient experienced vomiting and/or abdominal distension, bed head should be elevated to 30 to 40 degrees with administration of metoclopramide.</p