Objectives: To determine the effect of the enhanced protein-energy provision via the enteral route feeding protocol, combined with a nursing educational intervention on nutritional intake, compared to usual care.
Design: Prospective, cluster randomized trial.
Setting: Eighteen ICUs from United States and Canada with low baseline nutritional adequacy.
Patients: One thousand fifty-nine mechanically ventilated, critically ill patients.
Interventions: A novel feeding protocol combined with a nursing educational intervention.
Measurements and Main Results: The two primary efficacy outcomes were the proportion of the protein and energy prescriptions received by study patients via the enteral route over the first 12 days in the ICU. Safety outcomes were the prevalence of vomiting, witnessed aspiration, and ICU-acquired pneumonia. The proportion of prescribed protein and energy delivered by enteral nutrition was greater in the intervention sites compared to the control sites. Adjusted absolute mean difference between groups in the protein and energy increases were 14% (95% CI, 5–23%; p = 0.005) and 12% (95% CI, 5–20%; p = 0.004), respectively. The intervention sites had a similar improvement in protein and calories when appropriate parenteral nutrition was added to enteral sources. Use of the enhanced protein-energy provision via the enteral route feeding protocol was associated with a decrease in the average time from ICU admission to start of enteral nutrition compared to the control group (40.7–29.7 hr vs 33.6–35.2 hr, p = 0.10). Complication rates were no different between the two groups.
Conclusions: In ICUs with low baseline nutritional adequacy, use of the enhanced protein-energy provision via the enteral route feeding protocol is safe and results in modest but statistically significant increases in protein and calorie intake.
1Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, ON, Canada.
2Department of Community Health and Epidemiology, Queen’s University, Kingston, ON, Canada.
3Department of Medicine, Queen’s University, Kingston, ON, Canada.
4Specialized Complex Care Program, St. Michael’s Hospital, Toronto, ON, Canada.
5Department of Critical Care Medicine, Institute for Public Health, University of Calgary, Calgary, AB, Canada.
6Department of Medicine, Institute for Public Health, University of Calgary, Calgary, AB, Canada.
7Department of Community Health Sciences, Institute for Public Health, University of Calgary, Calgary, AB, Canada.
8Department of Nursing, Mount Royal College, Calgary, Canada.
9Department of Critical Care, Royal Alexandra Hospital, Edmonton, Alberta, Canada.
* See also p. 2825.
All authors contributed to the development of the study protocol, interpretation of data, and writing of the article. Heyland, Day, and Jiang were responsible for the analysis of the data and have access to the data.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).
Supported, in part, by Nestle Nutrition. Nestle had no role in the development, execution, or interpretation of the study.
Dr. Heyland’s institution received grant support from Nestle. He received honoraria from Nestle. He consulted and lectured for Abbott Nutrition. Dr. Tanguay received support for travel from the PepUP Study. She is the President of the Board of Directors for Canadian Association of Critical Care Nurses. She is employed by Alberta Health Services. The remaining authors have disclosed that they do not have any potential conflicts of interest.
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