The effects of an enteral nutrition feeding protocol on critically ill patients: A prospective multi-center, before-after study

• Published in: Journal of critical care 2020-04, Vol.56, p.249-256
• Main Authors: Jiang, Libing, Huang, Xiaoxia, Wu, Chunshuang, Tang, Jiaying, Li, Qiang, Feng, Xiuqin, He, Tao, Wang, Zhengquan, Gao, Jindan, Ruan, Zhanwei, Hong, Weili, Lai, Dengpan, Zhao, Fei, Huang, Zhiping, Lu, Zhifeng, Tang, Weidong, Zhu, Lijun, Zhang, Bingwen, Wang, Zhi, Shen, Xiaoyuan, Lai, Jiawei, Ji, Zhaohui, Fu, Kai, Hong, Yucai, Dai, Junru, Hong, Guangliang, Xu, Wenqing, Wang, Yi, Xie, Yun, Chen, Yuxi, Zhu, Xiuhua, Ding, Guojuan, Gu, Lanru, Zhang, Mao
• Format: Article
• Language: English
• Subjects: Calorie; Calories; China; Controlled Before-After Studies; Critical Illness - mortality; Critically ill; Energy Intake; Enteral nutrition; Enteral Nutrition - methods; Female; Hospital Mortality; Hospitalization; Humans; Intensive care; Intensive Care Units; Length of Stay; Male; Malnutrition; Medical prognosis; Middle Aged; Mortality; Multivariate Analysis; Nutrition; Parenteral nutrition; Patient Admission; Patients; Prognosis; Prospective Studies; Protocol; Respiration, Artificial - adverse effects
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2020.01.018

The aim of this study was to explore the effects of an enteral nutrition (EN) feeding protocol in critically ill patients. This was a prospective multi-center before-after study. We compared energy related and prognostic indicators between the control group (pre-implementation stage) and intervention group (post-implementation stage). The primary endpoint was the percentage of patients receiving EN within 7 days after ICU admission. 209 patients in the control group and 230 patients in the intervention group were enrolled. The implementation of the EN protocol increased the percentage of target energy reached from day 3 to day 7, and the difference between two groups reached statistical significance in day 6 (P = .01) and day 7 (P = .002). But it had no effects on proportion of patient receiving EN (P = .65) and start time of EN (P = .90). The protocol application might be associated with better hospital survival (89.1% vs 82.8%, P = .055) and reduce the incidence of EN related adverse (P = .004). There was no difference in ICU length of stay, duration of mechanical ventilation and ICU cost. The implementation of the enteral feeding protocol is associated with improved energy intake and a decreased incidence of enteral nutrition related adverse events for critically ill patients, but it had no statistically beneficial effects on reducing the hospital mortality rate. Trial registration ClinicalTrials.gov, NCT02976155. Registered November 29, 2016- Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02976155. •The application of an EN protocol could not increase the proportion of EN (P = .65), and accelerate implementation of EN (P = .90).•Use of an EN protocol was associated with a higher percentage of target energy reached from day 3 to day 7 after ICU admission.•Implementation of EN protocol marginally improved hospital survival (P = .05).•There was no effects of an EN protocol on ICU length of stay, duration of mechanical ventilation and ICU cost.•The application of an EN protocol could decrease the incidence of EN related adverse events (P = .004).