This Article Full Text Full Text (PDF) An erratum has been published Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Mackenzie, S. L. Articles by Hameed, S. M. Search for Related Content PubMed PubMed Citation Articles by Mackenzie, S. L. Articles by Hameed, S. M. Social Bookmarking                         What's this?

Implementation of a Nutrition Support Protocol Increases the Proportion of Mechanically Ventilated Patients Reaching Enteral Nutrition Targets in the Adult Intensive Care Unit

Shannon L. Mackenzie, BSc, RD^*,, David A. Zygun, MD, FRCPC^,,¶, Bev L. Whitmore, MBA, RD^*, Christopher J. Doig, MD, MSc, FRCPC^,, and Syed Morad Hameed, MD, MPH, FRCSC^,||

From the ^* Departments of Clinical Nutrition, Critical Care Medicine, Medicine, Community Health Sciences,^|| Surgery, and^¶ Clinical Neuroscience, Calgary Health Region and University of Calgary, Calgary, Canada

Correspondence: Shannon Mackenzie, BSc, RD, Clinical Nutrition, Calgary Health Region, Foothills Medical Centre, 1403–29 St NW, Calgary, AB, T2N 2T9 Canada. Electronic mail may be sent to shannon.mackenzie{at}calgaryhealthregion.ca.

Background: Despite the evidence that enteral feeding reduces morbidity in critically ill patients and is preferred to parenteral nutrition, the delivery of enteral nutrition (EN) is often inadequate. The purpose of this study was to determine whether implementation of an evidence-based nutrition support (NS) protocol could improve EN delivery. Methods: An NS protocol incorporating available scientific evidence; data from a retrospective survey of 30 intensive care unit (ICU) patients; and input from dietitians, intensive care physicians, surgeons, nurses, and pharmacists was developed. The impact of this protocol was evaluated prospectively in 123 consecutive adult patients admitted to a multisystem ICU who were eligible for EN. Results: The percentage of patients who received at least 80% of their estimated energy requirements during their ICU stay increased from 20% before implementation of the NS protocol to 60% after implementation (p < .001). After adjusting for confounders, those in the postimplementation group received significantly more kcal/kg/d than the preimplementation group (3.71 kcal/kg/d; 95% confidence interval, 1.64 to 5.78; p = .001). Parenteral nutrition kcal/kg/d use was reduced in the postimplementation group (1.6 vs 13%, p = .02). There was no difference in time to initiation of enteral nutrition between groups (1.76 days preprotocol vs 1.44 days postprotocol implementation, p = .9). Conclusions: The development and use of an evidence-based NS protocol improved the proportion of enterally fed ICU patients meeting their calculated nutrition requirements.

Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 2, 74-80 (2005)
DOI: 10.1177/014860710502900274


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				S. L. Brantley Implementation of the Enteral Nutrition Practice Recommendations Nutr Clin Pract, June 1, 2009; 24(3): 335 - 343. [Abstract] [Full Text] [PDF]

				D. O'Meara, E. Mireles-Cabodevila, F. Frame, A. C. Hummell, J. Hammel, R. A. Dweik, and A. C. Arroliga Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation Am. J. Crit. Care., January 1, 2008; 17(1): 53 - 61. [Abstract] [Full Text] [PDF]

				P. E. Spronk, J. H. Rommes, and M. A. Kuiper Structural Underfeeding Due to Inaccurate Feeding Pumps? JPEN J Parenter Enteral Nutr, March 1, 2007; 31(2): 154 - 154. [Full Text] [PDF]