Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Aug 3;12(8):e0182393.
doi: 10.1371/journal.pone.0182393. eCollection 2017.

Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study

Qian Li  1 , Zhongheng Zhang  2 , Bo Xie  3 , Xiaowei Ji  3 , Jiahong Lu  3 , Ronglin Jiang  4 , Shu Lei  4 , Shihao Mao  4 , Lijun Ying  5 , Di Lu  5 , Xiaoshui Si  6 , Mingxia Ji  6 , Jianxing He  6 , Mengyan Chen  6 , Wenjuan Zheng  6 , Jiao Wang  6 , Jing Huang  6 , Junfeng Wang  6 , Yaling Ji  6 , Guodong Chen  7 , Jianhua Zhu  7 , Yadi Shao  7 , Ronghai Lin  8 , Chao Zhang  8 , Weiwen Zhang  9 , Jian Luo  9 , Tianzheng Lou  10 , Xuwei He  10 , Kun Chen  11 , Wei Peng  11 , Renhua Sun  1
Affiliations

Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study

Qian Li et al. PLoS One. .

Abstract

Background and objective: Enteral nutrition (EN) feeding protocol was proposed to have positive impact on critically ill patients. However, current studies showed conflicting results. The present study aimed to investigate whether enteral feeding protocol was able to improve clinical outcomes in critically ill patients.

Methods: A before (stage 1) and after (stage 2) interventional study was performed in 10 tertiary care hospitals. All patients expected to stay in the intensive care unit (ICU) for over three days were potentially eligible. Clinical outcomes such as 28-day mortality, ICU length of stay, duration of mechanical ventilation (MV), and nosocomial infection were compared between the two stages.

Main results: A total of 410 patients were enrolled during the study period, including 236 in stage 1 and 174 in stage 2. EN feeding protocol was able to increase the proportion of EN in day 2 (41.8±22.3 vs. 50.0±28.3%; p = 0.006) and day 6 (70.3±25.2 vs. 77.6±25.8%; p = 0.006). EN percentages tended to be higher in stage 1 than that in stage 2 on other days, but statistical significance was not reached. There was no difference in 28-day mortality between stage 1 and 2 (0.14 vs. 0.14; p = 0.984). Implementation of EN feeding protocol marginally reduced ICU length of stay (19.44±18.48 vs. 16.29±16.19 days; p = 0.077). There was no difference in the duration of MV between stage a and stage 2 (14.24±14.49 vs. 14.51±17.55 days; p = 0.877).

Conclusions: The study found that the EN feeding protocol was able to increase the proportion of EN feeding, but failed to reduce 28-day mortality, incidence of nosocomial infection or duration of MV.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Enteral feeding algorithm.
Before EN initiation, Hemodynamic should be stabilized with MAP>65 mmHg and lactate<4 mmol/l, or vasopressor dose was decreasing. GI function was then evaluated with the AGI staging system. For pateints with AGI of I, EN could be started at 25 ml/h. For patients with AGI II-III, predigested EN could be started at 10–15 ml/h. EN was withheld for those with AGI IV. If patients were at high risk of malnutrition, parenteral nutrition (PN) should started.
Fig 2
Fig 2. Protocols for the management of adverse events.
EN was discontinued if persistent abdominal pain occurred. Physical examination and abdominal computed tomography would be ordered. If there was bowel obstruction or ischemia, EN would be discontinued. Diarrhea could be caused by enteral feeding, specific diseases and drugs. If clostridium difficile (CD) infection was identified, the patient should be treated with metronidazole or vancomycin. If the patient experienced vomiting and/or abdominal distension, bed head should be elevated to 30 to 40 degrees with administration of metoclopramide.
Fig 3
Fig 3. Subject enrollment in each participating center over the study period.
Fig 4
Fig 4. Missing pattern of some important variables.
Fig 5
Fig 5. Comparisons of EN proportion between stage 1 and 2.
Patients in stage 2 received more EN than that in stage 1. The proportion of EN increased from day 1 to day 7.
Fig 6
Fig 6. Visualization of the interaction between age and stage.
EN feeding protocol tended to benefit younger patients, and was less likely to benefit old ones.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Zhang Z, Chen K, Ni H, Fan H. Predictive value of lactate in unselected critically ill patients: an analysis using fractional polynomials. J Thorac Dis. 2014;6: 995–1003. doi: 10.3978/j.issn.2072-1439.2014.07.01 - DOI - PMC - PubMed
    1. Stuani Franzosi O, Delfino von Frankenberg A, Loss SH, Silva Leite Nunes D, Rios Vieira SR . Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials. Nutr Hosp. 2017;34: 19–29. doi: 10.20960/nh.443 - DOI - PubMed
    1. Hofman Z, Swinkels S, van Zanten ARH. Glutamine, fish oil and antioxidants in critical illness: MetaPlus trial post hoc safety analysis. Ann Intensive Care. Springer Paris; 2016;6: 119 doi: 10.1186/s13613-016-0220-y - DOI - PMC - PubMed
    1. Havens JM, Columbus AB, Seshadri AJ, Olufajo OA, Mogensen KM, Rawn JD, et al. Malnutrition at Intensive Care Unit Admission Predicts Mortality in Emergency General Surgery Patients. JPEN J Parenter Enteral Nutr. SAGE PublicationsSage CA: Los Angeles, CA; 2016;43: 014860711667659. doi: 10.1177/0148607116676592 - DOI - PubMed
    1. Lew CCH, Yandell R, Fraser RJL, Chua AP, Chong MFF, Miller M. Association Between Malnutrition and Clinical Outcomes in the Intensive Care Unit: A Systematic Review. JPEN J Parenter Enteral Nutr. SAGE PublicationsSage CA: Los Angeles, CA; 2016;5: 014860711562563. doi: 10.1177/0148607115625638 - DOI - PubMed