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Smith LD, Hoy H, Whitmore S. Increasing the Volume of Delivered Enteral Feeds Using a Volume-Based Feeding Protocol in a Neuroscience Intensive Care Unit. Crit Care Nurse 2024; 44:54-64. [PMID: 38821527 DOI: 10.4037/ccn2024622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2024]
Abstract
BACKGROUND Iatrogenic malnutrition is a significant burden to patients, clinicians, and health care systems. Compared with well-nourished patients, underfed patients (those who receive less than 80% of their daily energy requirement) have more adverse outcomes related to nutritional status. Volume-based protocols allow for catch-up titrations, are consistently superior to rate-based protocols, and can be implemented in most settings. LOCAL PROBLEM This project was conducted in an 8-bed neuroscience intensive care unit in which up to 41% of patients who required enteral feeding were underfed. METHODS This quality improvement clinical practice change project used a before-and-after design to evaluate (1) the effect of implementing a volume-based feeding protocol on the delivery of enteral feeds and (2) the effect of a nutrition-based project on staff members' attitudes regarding nutrition in critical care. The effectiveness of a volume-based feeding titration protocol was compared with that of a rate-based feeding protocol for achieving delivery of at least 80% of prescribed nutrition per 24-hour period. Staff members' attitudes were assessed using a survey before and after the project. RESULTS During 241 enteral feeding days (n = 40 patients), the percentage of delivered enteral feeding volume and the percentage of days patients received at least 80% of the prescribed volume increased after volume-based feeding was implemented. After project implementation, 74 staff members reported increased emphasis on nutrition delivery in their practice and a higher level of agreement that nutrition is a priority when caring for critically ill patients. CONCLUSIONS Using a volume-based feeding protocol with supplemental staff education resulted in improved delivery of prescribed enteral feeding.
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Affiliation(s)
- L Douglas Smith
- L. Douglas Smith Jr is the lead critical care advanced practice provider and critical care nurse practitioner, HCA Healthcare Intensivist Services, HCA Healthcare TriStar Centennial Medical Center, Nashville, Tennessee, and a faculty member at Vanderbilt University School of Nursing, Nashville
| | - Haley Hoy
- Haley Hoy is a professor, University of Alabama in Huntsville College of Nursing, Huntsville, Alabama, and a lung transplant nurse practitioner at Vanderbilt University Medical Center, Nashville
| | - Sage Whitmore
- Sage Whitmore is the Medical Director for the intensive care unit and a staff intensivist, HCA Intensivist Services, HCA TriStar Centennial Medical Center
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Wang L, Wang Y, Li HX, Zhang RP, Chang L, Zeng J, Jiang H. Optimizing enteral nutrition delivery by implementing volume-based feeding protocol for critically ill patients: an updated meta-analysis and systematic review. Crit Care 2023; 27:173. [PMID: 37147701 PMCID: PMC10161662 DOI: 10.1186/s13054-023-04439-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 04/11/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND This study aims to provide an updated assessment of the efficacy of optimized enteral nutrition (EN) delivery by implementing the volume-based feeding (VBF) protocol in critically ill patients. METHODS We updated our previous literature retrieval with no language restrictions. The inclusion criteria were:1) Participants: Critically ill patients (Patients who was admitted in ICU; 2) Intervention: The VBF protocol was adopted for EN administration; 3) Comparison: The rate-based feeding (RBF) protocol was adopted for EN administration; 4) Major outcomes: EN nutrition delivery. The exclusion criteria included participants aged < 18 years, duplicated literature, animal and cellular experiments, and studies lacking any of the outcomes mentioned in the inclusion criteria. The databases included MEDLINE (through PubMed), Web of Science, Cochrane Library, Chinese Biomedical Literature Service System (SinoMed), Wanfang Data Knowledge Service Platform, and China National Knowledge Infrastructure. RESULT Sixteen studies involving a total of 2896 critically ill patients are included in the updated meta-analysis. Compared with the previous meta-analysis, nine new studies were added that included 2205 more patients. The VBF protocol significantly improved energy (MD = 15.41%, 95% CI: [10.68, 20.14], p < 0.00001) and protein (MD = 22.05%, 95% CI: [10.89, 33.22], p = 0.0001) delivery. The patients in the VBF group stayed in the ICU for a shorter time (MD = 0.78, 95% CI: [0.01, 1.56], p = 0.05). The VBF protocol did not increase the risk of death (RR = 1.03, 95% CI: [0.85, 1.24], p = 0.76) or prolong the mechanical ventilation duration (MD = 0.81, 95% CI: [-0.30,1.92], p = 0.15). In addition, the VBF protocol did not affect EN complications, such as diarrhea (RR = 0.91, 95% CI: [0.73, 1.15], p = 0.43), emesis (RR = 1.23, 95% CI: [0.76, 1.99], p = 0.41), feeding intolerance (RR = 1.14, 95% CI: [0.63, 2.09], p = 0.66), and gastric retention (RR = 0.45, 95% CI: [0.16, 1.30], p = 0.14). CONCLUSION Our study revealed that the VBF protocol significantly improved calorie and protein delivery in critically ill patients with no additional risk.
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Affiliation(s)
- Lu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Yu Wang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Hua-Xin Li
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Rui-Peng Zhang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Li Chang
- Department of Emergency Intensive Care Unit, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan Province, China
| | - Jun Zeng
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
| | - Hua Jiang
- Institute for Emergency and Disaster Medicine, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Sichuan Provincial Research Center for Emergency Medicine and Critical Illness, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China.
- Department of Emergency Intensive Care Unit, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan Province, China.
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Ding C, Chen Q, Zhang F, Xu B, Zhang H. Effect of a Personalized Enteral Nutrition Protocol on the Postoperative Nutritional Status in Patients Who Underwent Oral Cancer Surgery. Nutr Cancer 2023; 75:815-824. [PMID: 36533888 DOI: 10.1080/01635581.2022.2157449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Differences in the implementation of the perioperative nutrition guidelines and pathways by caregivers lead to differences in enteral nutrition provided to the patients. This study investigated the effect of a personalized enteral nutrition protocol on the postoperative nutritional status of patients who underwent oral cancer surgery at Zhejiang Ningbo NO. 2 Hospital. Those who underwent surgery between July 2017 and October 2018 received routine enteral nutrition based on the Nutritional Risk Screening 2002 (routine group), while those between November 2018 and August 2021 received personalized enteral nutrition based on the Patient-Generated Subjective Global Assessment tool (personalized group). Seventy patients completed the study (routine group, n = 34; personalized group, n = 36). After surgery, the personalized group exhibited significantly greater improvements in serum albumin levels (P < 0.01) (on the 7th and 10th day) and hand grip strength (P < 0.01), higher self-care ability (P < 0.01), lower incidence of gastrointestinal reactions during enteral feeding (P < 0.05), and shorter hospital stay (P < 0.05) than the routine group. Therefore, a personalized enteral nutrition program might improve the postoperative nutritional status, shorten the hospital stay, and accelerate postoperative recovery in patients who underwent oral cancer surgery.
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Affiliation(s)
- Chunbo Ding
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Qing Chen
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Feng Zhang
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Bin Xu
- Department of Stomatology, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
| | - Huiqin Zhang
- Department of Nutrition, Ningbo Huamei Hospital, University of Chinese Academy of Sciences, Ningbo No.2 Hospital, Ningbo, China
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Bond A, Czapran A, Lal S. Small bowel feeding: do you pay the price for bypassing the stomach? Curr Opin Clin Nutr Metab Care 2022; 25:116-121. [PMID: 34966116 DOI: 10.1097/mco.0000000000000804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Hydration and nutritional support is a vital part of medical care, thus a clear understanding of the optimal approach is vital for medical professionals. This is a particularly pertinent issue for patients admitted to a critical care setting. This article aims to define the advantages and disadvantages of gastric and postpyloric feeding in the critical care setting, thus aiding decision-making for clinicians. RECENT FINDINGS Within the article, the main themes covered are those relating to enteral feeding tube placement, the impact of enteral feeding route on ventilator-associated pneumonia, optimization of enteral tube feeding in critical care and the impact that a chosen route may have upon gastrointestinal function. SUMMARY The value of enteral feeding in critical illness is proven beyond doubt and the simplest approach has long been 'if the gut works, use it'. If gastric feeding is not able to be established or is not tolerated then jejunal feeding should be considered as a preferable alternative to parenteral nutrition. Improving access to service or techniques for postpyloric tube placement would assist in optimizing nutritional support in the critical care setting.
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Affiliation(s)
- Ashley Bond
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford
| | - Adam Czapran
- Department of Critical Care, Kings College NHS Foundation Trust, London
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford
- University of Manchester, Manchester, UK
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