Feeding ICU patients on invasive mechanical ventilation: designing the optimal protocol

Improving Nutrition in Mechanically Ventilated Patients

BACKGROUND

Although proper diet has been found to play an important role in patient outcomes, studies have shown that intensive care unit patients often receive inadequate nutrition. Moreover, it has been found that critically ill patients who are mechanically ventilated regularly receive even less nutrition. Inadequate nutrition has been associated with impaired immune response, increased susceptibility to infection, poor wound healing, and neuromuscular impairment. These factors lead to prolonged dependence on ventilators, protracted length of stay, and increased morbidity and mortality. This study investigates the use of an enteral nutrition (EN) protocol and its ability to prompt earlier initiation of feedings and more complete nutrition in mechanically ventilated patients to minimize such complications.

METHODS

In a sample of 51 mechanically ventilated patients admitted to an intensive care unit, percentage of prescribed calories received and percentage of feedings initiated with 24-48 hours of intubation were calculated before and after the initiation of an EN protocol.

RESULTS

In the postintervention group (n = 18), 83.3% received EN with the first 24-48 hours after intubation, compared with 54.5% in the preintervention group (n = 33). In the postintervention group, 77.8% received at least 60% of their prescribed feeding goal compared with 63.6% of the preintervention group.

CONCLUSION

Findings show that the use of an EN protocol when caring for mechanically ventilated patients leads to earlier initiation of feedings as well as more complete nutrition.

WITHDRAWN: Early enteral nutrition versus late enteral nutrition for burns patients: A systematic review and meta-analysis

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Enhanced Protein-Energy Provision via the Enteral Route in Critically Ill Patients (PEP uP Protocol): A Review of Evidence

Nutrition support is an integral part of care among critically ill patients. However, critically ill patients are commonly underfed, leading to consequences such as increased length of hospital and intensive care unit stay, time on mechanical ventilation, infectious complications, and mortality. Nevertheless, the prevalence of underfeeding has not resolved since the first description of this problem more than 15 years ago. This may be due to the traditional conservative feeding approaches. A novel feeding protocol (the Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol in Critically Ill Patients [PEP uP] protocol) was proposed and proven to improve feeding adequacy significantly. However, some of the components in the protocol are controversial and subject to debate. This article is a review of the supporting evidences and some of the controversy associated with each component of the PEP uP protocol.