A Volume-Based Feeding Protocol Improves Nutrient Delivery and Glycemic Control in a Surgical Trauma Intensive Care Unit.
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
07 2020
07 2020
Historique:
received:
05
03
2019
revised:
11
07
2019
accepted:
29
08
2019
pubmed:
19
9
2019
medline:
4
3
2021
entrez:
19
9
2019
Statut:
ppublish
Résumé
Inadequate delivery of nutrition in critically ill patients has been shown to have adverse outcomes. A surgical trauma intensive care unit provides unique challenges to enteral feeds. Although volume-based feeding protocols, like Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP), have been successfully used in medical intensive care patients, data are sparse on its safety and efficacy in a surgical intensive care unit population. A PEP uP protocol was recently initiated at our American College of Surgeons Level 1 verified trauma center. Medical records of 197 patients before this change (pre-PEP uP) were compared with 295 patients after this change (post-PEP uP). The post-PEP uP group met/exceeded energy goals (defined as 80% of target) more often (57.0% compared with 26.9%, P-value < .001), with an adjusted odds ratio (OR) of 4.98 (95% CI 3.49-7.10), and more often met/exceeded protein goals (57.4% compared with 18.6%, P-value < .001), with an adjusted OR of 11.84 (95% CI 7.94-17.64). There was no significant difference in emesis during this time. Additionally, patients in the post-PEP uP arm had less episodes of hyperglycemia (9% compared with 14.4%, P-value < .001). Volume-based feeding protocols like PEP uP are safe in critically ill trauma patients and are more effective at delivering energy and protein while limiting hyperglycemic episodes when compared with a traditional delivery method.
Sections du résumé
BACKGROUND
Inadequate delivery of nutrition in critically ill patients has been shown to have adverse outcomes. A surgical trauma intensive care unit provides unique challenges to enteral feeds. Although volume-based feeding protocols, like Enhanced Protein-Energy Provision via the Enteral Route Feeding Protocol (PEP uP), have been successfully used in medical intensive care patients, data are sparse on its safety and efficacy in a surgical intensive care unit population.
METHODS
A PEP uP protocol was recently initiated at our American College of Surgeons Level 1 verified trauma center. Medical records of 197 patients before this change (pre-PEP uP) were compared with 295 patients after this change (post-PEP uP).
RESULTS
The post-PEP uP group met/exceeded energy goals (defined as 80% of target) more often (57.0% compared with 26.9%, P-value < .001), with an adjusted odds ratio (OR) of 4.98 (95% CI 3.49-7.10), and more often met/exceeded protein goals (57.4% compared with 18.6%, P-value < .001), with an adjusted OR of 11.84 (95% CI 7.94-17.64). There was no significant difference in emesis during this time. Additionally, patients in the post-PEP uP arm had less episodes of hyperglycemia (9% compared with 14.4%, P-value < .001).
CONCLUSIONS
Volume-based feeding protocols like PEP uP are safe in critically ill trauma patients and are more effective at delivering energy and protein while limiting hyperglycemic episodes when compared with a traditional delivery method.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
880-888Informations de copyright
© 2019 American Society for Parenteral and Enteral Nutrition.
Références
Villet S, Chiolero RL, Bollmann MD, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005;24(4):502-509.
Silva, CFA, de Vasconcelos SG, da Silva TA, Silva FM. Permissive or trophic enteral nutrition and full enteral nutrition had similar effects on clinical outcomes in intensive care: a systemic review of randomized clinical trials. Nutr Clin Pract. 2018;33(3):388-396.
Monk D, Plant L, Franch-Arcas G, Finn P, Streat S, Hill G. Sequential changes in the metabolic response in critically injured patients during the first 25 days after blunt trauma. Ann Surg. 1996;223(4):395-405.
McClave, SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211.
McClave SA, Saad MA, Esterle M, et al. Volume-based feeding in the critically ill patient. JPEN J Parenter Enteral Nutr. 2015;39(6):707-712.
Yeh D, Fuentes E, Quraishi S, et al. Adequate nutrition may get you home: effect of caloric/protein deficits on the discharge destination of critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2016;40(1):37-44.
Heyland DK, Murch L, Cahill N, et al. Enhanced protein-energy provision via the enteral route feeding protocol in critically ill patients: results of a cluster randomized trial. Crit Care Med. 2013;41(12):2734-2753.
Heyland, D.K., Cahill NE, Dhaliwal R, et al. Enhanced protein-energy provision via the enteral route in critically ill patients: a single center feasibility trial of the PEP uP protocol. Crit Care. 2010;14(2):R78.
Urisman T, Garcia A, Harris H. Impact of surgical intensive care unit interdisciplinary rounds on interprofessional collaboration and quality of care: mixed qualitative-quantitative study. Intensive Crit Care Nurs. 2018;44:18-23.
Braggs J, Schmitt M, Mushlin A, et al. Association between nurse-physician collaboration and patient outcomes in three intensive care units. Crit Care Med. 1999;27(9):1991-1998.
Cao V, Tan L, Horn F, et al. Patient-centered structured interdisciplinary bedside rounds in the medical ICU. Crit Care Med. 2018;46(1):85-92.
Binnekade JM, Tepaske R, Bruynzeel P, Mathus-Vliegen EM, de Hann RJ. Daily enteral feeding practice on the ICU: attainment of goals and interfering factors. Crit Care. 2005;9(3):R218-R225.
Haskins IN, Baginsky M, Gamsky N, et al. Volume-based enteral nutrition support regimen improves caloric delivery but may not affect clinical outcomes in critically ill patients. JPEN J Parenter Enteral Nutr. 2017;41(4):607-611.
Frankenfield, D, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. JPEN J Parenter Enteral Nutr. 2009;33(1):27-36.
Roberts S, Brody R, Rawal S, Byham-Gray L. Volume-based vs rate-based enteral nutrition in the intensive care unit: impact on nutrition delivery and glycemic control. JPEN J Parenter Enteral Nutr. 2019;43(3):365-375.
Lee JC, Williams GW, Kozar RA, et al. Multitargeted feeding strategies improve nutrition outcome and are associated with reduced pneumonia in a level 1 trauma intensive care unit. JPEN J Parenter Enteral Nutr. 2018;42(3):529-537.
Van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359-1367.
Kavanagh BP, McCowen KC. Clinical practice. Glycemic control in the ICU. N Engl J Med. 2010;363(26):2540-2546.
Griesdale, DEG, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patient: a meta-analysis including NICE-SUGAR study data. CMAJ. 2009;180(8):821-827.
Yeh DD, Ortiz LA, Lee JM, et al. PEP uP (enhanced protein-energy provision via the enteral route feeding protocol) in surgical patients - a multicenter pilot randomized controlled trial. JPEN J Parenter Enteral Nutr. 2020;44(2):197-204.
John J, Seifi A. Total parenteral nutrition usage trends in the United States. J Crit Care. 2017;40:312-313.