Evaluation of over- and underfeeding following the introduction of a protocol for weaning from parenteral to enteral nutrition in the intensive care unit

Abstract

Background: Over- and underfeeding critically ill patients have significant clinical consequences. These patients are often given a combination of enteral nutrition (EN) and parenteral nutrition (PN), potentially increasing their risk of overfeeding. No published protocol describing the process for weaning from parenteral to enteral feeding and its effects on over- and underfeeding exists. This study aimed to evaluate the introduction of such a protocol.

Materials and methods: A prospective, 2-phase observational study was performed in a 10-bed medical/surgical intensive care unit on patients ventilated for >72 hours and receiving EN and/or PN. Data were collected 6 months before and 2 years after the implementation of a weaning protocol. Underfeeding was defined as energy intake <80% and overfeeding as >110% of estimated requirements.

Results: Twenty-two patients were fed for a total of 118 days in phase 1, and 29 patients were fed for a total of 272 days in phase 2. Overfeeding occurred more frequently than underfeeding prior to the introduction of the protocol (24.6% vs 19.5% of feeding days) and significantly more often on days when patients were fed by a combination of routes (P < .05). After implementing the protocol, the incidence of overfeeding reduced almost 3-fold to 9.1% (P < .001), and feeding via a combination of routes was no longer a significant cause. Underfeeding did not change and patients being adequately fed increased from 56% to 71% (P < .001).

Conclusion: A structured protocol for weaning patients from PN to EN can reduce overfeeding in critically ill patients given nutrition support via a combination of routes.