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Evaluating the Effects of Implementing a Volume-Based Protocol in an ICU setting
Conniff, Sarah
Conniff, Sarah
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Abstract
Background: Patients in ICUs tend to have greater protein and calorie needs than other hospital populations, especially patients who cannot eat by mouth. Meeting these needs is crucial to patient recovery, yet for many reasons, tube feeds are held. This study was conducted to evaluate the effectiveness of a volume-based (VB) enteral nutrition protocol implementation in general and medical ICUs. It is hypothesized that the volume-based method would be superior in delivering appropriate amounts of calories and protein to patients without causing undesirable side effects. Materials and Methods: ICU patients (n=116) tolerating EN at goal for 24 hours were retrospectively reviewed in this study. Patients had EN delivered via VB (n=59) or rate-based delivery (n=57). Results: The intervention group achieved significantly more goal calories, (SD=24.91, p=0.013), goal protein (SD=26.87, p=0.005), and goal volume of EN formula (SD=22.14, p=0.002), when compared with the control group. There was, also, a significant increase in patients who met 80% or more of their protein goal (CI 95%= 5.4% to 38.5%, p=0.011). Patients in the intervention group experienced fewer high GRV (p=0.0144) and less occurrence of diarrhea (p=0.0330). Time to reach goal rate took significantly less time in the intervention group (p=0.0198). There were no differences seen between groups for distal tube tip placement, use of promotility agents, occurrence of nausea, vomiting, constipation, malnutrition, 60-day mortality rates, or occurrence of pressure injuries. Conclusion: Implementation of a volume-based protocol in an ICU setting has been shown to significantly improve amounts of calories and protein delivered to patients receiving enteral nutrition while not increasing the incidence of gastric residual volumes or diarrhea.
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Date
2019-05-31
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University of Kansas
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Keywords
Nutrition, Enteral Nutrition, Feeding Protocol, ICU, Nutrition, Tube Feeding, Volume-Based