Abstract
Malnutrition is common in intensive care units (ICU), and volume based feeding protocols have been proposed to increase nutrient delivery. However, the volume based approach compared to trophic feeding has not been proven entirely successful in critically ill patients. Our study aimed to compare the clinical outcomes both before and after the implementation of the feeding protocol, and to also evaluate the effects of total energy delivery on outcomes in these patients. We retrospectively collected all patient data, one year before and after the implementation of the volume-based feeding protocol, in the ICU at Taichung Veterans General Hospital. Daily actual energy intake from enteral nutritional support was recorded from the day of ICU admission until either the 7th day of ICU stay, or the day of discharge from the ICU. The energy achievement rate (%) was calculated as: (actual energy intake/estimated energy requirement) × 100%. Two-hundred fourteen patients were enrolled before the implementation of the volume-based feeding protocol (pre-FP group), while 198 patients were enrolled after the implementation of the volume-based feeding protocol (FP group). Although patients in the FP group had significantly higher actual energy intakes and achievement rates when compared with the patients in the pre-FP group, there was no significant difference in mortality rate between the two groups. Comparing survivors and non-survivors from both groups, an energy achievement rate of less than 65% was associated with an increased mortality rate after adjusting for potential confounders (odds ratio, 1.6, 95% confidence interval, 1.01–2.47). The implementation of the feeding protocol could improve energy intake for critically ill patients, however it had no beneficial effects on reducing the ICU mortality rate. Receiving at least 65% of their energy requirements is the main key point for improving clinical outcomes in patients.
Highlights
Malnutrition is common in intensive care units (ICU); where the prevalence is approximately40 to 80% [1,2,3]
Except for age difference, there were no significant differences in gender, BMI, clinical outcomes, or mortality rate between pre-FP and FP groups
Patients in the FP group had significantly higher actual energy intakes and achievement rates when compared with patients in the pre-FP group
Summary
Malnutrition is common in intensive care units (ICU); where the prevalence is approximately40 to 80% [1,2,3]. To improve the provision of energy and protein in critically ill patients, the volume based feeding protocol has been implemented to enhance the infusion rate, in order to cover the interruption in delivery This strategy has been proven to be safe, and could meet energy requirements for critically ill patients [21,22]. Introduced provision guidelines for critically ill adult patients, as set by the Society of Critical Care Medicine (SCCM) and the American Society for Parenteral Enteral Nutrition (ASPEN) [6], highlight the importance of the volume-based feeding protocol They recommend that this feeding protocol be used in the adult ICU, in order to reach the goal of calories provided [6]. Based on the beneficial effects that volume-based feeding offers, the feeding protocol has been implemented in our ICU since June 2015 at Taichung Veterans General
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