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. 2022 Aug;37(3):382-390.
doi: 10.4266/acc.2022.00220. Epub 2022 Jul 19.

Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study

Heemoon Park  1 , Sung Yoon Lim  2 , Sebin Kim  3 , Hyung-Sook Kim  3 , Soyeon Kim  3 , Ho Il Yoon  2 , Young-Jae Cho  2
Affiliations

Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study

Heemoon Park et al. Acute Crit Care. 2022 Aug.

Abstract

Background: Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The "new ICU evaluation & development of nutritional support protocol (NICE-NST)" was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.

Methods: This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).

Results: In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).

Conclusions: The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.

Keywords: clinical protocols; complications; critical care outcomes; critical illness; enteral nutrition; nutritional support.

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Conflict of interest statement

CONFLICT OF INTEREST

No potential conflict of interest relevant to this article was reported.

Figures

Figure 1.
Figure 1.
Protocol for enteral nutrition and residual volume check in new intensive care unit (ICU) evaluation & development of nutritional support protocol (NICE-NST) protocol. Enteral nutrition (EN) is supplied for 16 hours from 9 AM to 1 AM the next day. Gastric residual volume (GRV) check was done thrice daily at 9 AM, 5 PM, and 11 PM. If GRV is over 250 ml, EN feeding is held, and prokinetics are given thrice daily as scheduled by the nurse on duty. Two hours after withholding EN feeding, GRV recheck is performed, and the same protocol is repeated until 1 AM the next day.
Figure 2.
Figure 2.
Flowchart of the study participant selection. The control group was supplied nutrition without protocol, while the test group was supplied nutrition with protocol. ICU: intensive care unit; NST: nutrition support team; CRRT: continuous renal replacement therapy; HD: hemodialysis. Admission to NST time: the time duration from admission in ICU to NST consultation.
Figure 3.
Figure 3.
Trends of supplying calorie and protein over time in control or test group. (A) Total calorie per weight supplied during intensive care unit (ICU) day 1 to 5. (B) Total protein per weight supplied during ICU day 1 to 5. (C) Enteral nutrition (EN) calorie per weight supplied during ICU day 1 to 5. (D) EN protein per weight supplied during ICU day 1 to 5. Differences between the two groups were tested with repeated-measures analysis of variance.
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