Background: Underfeeding in intensive care patients on enteral nutrition is commonplace and multifactorial. This can be exacerbated by interruptions caused by routine fasting for procedures and investigations. Our study aims to demonstrate that a volume based feeding protocol can overcome the barriers of underfeeding and safely increase energy and protein delivery in UK intensive care patients, potentially improving clinical outcomes.
Methods: In this single centre cohort study, data were collected from adult mechanically ventilated patients. We compared the standard care of rate based feeding, from an International Nutrition Survey (2014/15) to the new intervention of volume based feeding, in a mixed medical and surgical intensive care unit. The primary outcomes were the proportion of energy and protein daily targets delivered. Secondary outcomes compared the effects on gastrointestinal tolerance, glycaemic control, mortality, mechanical ventilation days, length of stay in intensive care unit and hospital.
Results: From a total of 82 patients (rate based feeding = 27, volume based feeding = 55), volume based feeding patients received significantly more prescribed energy (52% versus 81%; p < 0.001) and protein (40% versus 74%; p < 0.001). There was no significant difference in gastrointestinal symptoms such as gastric residual volumes (p = 0.62), glycaemic control (p = 0.94) or insulin usage (p = 0.75). Although there was an improvement in energy and protein delivery, there were no differences in mechanical ventilation days (p = 0.12), mortality (p = 0.06), length of stay in intensive care unit (p = 0.93) and hospital (p = 0.72) between the groups.
Conclusion: Compared to rate based feeding, volume based feeding significantly improved energy and protein provision with no adverse effects on glycaemic control or gastrointestinal tolerance, clinical outcomes were not affected.
Keywords: Underfeeding; clinical outcome; enteral nutrition; intensive care; rate based feeding; volume based feeding.
© The Intensive Care Society 2019.
[Impact of permissive underfeeding versus standard enteral feeding on outcomes in critical patients requiring mechanical ventilation: a prospective randomized controlled study].Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018 Feb;30(2):176-180. doi: 10.3760/cma.j.issn.2095-4352.2018.02.016. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2018. PMID: 29402370 Clinical Trial. Chinese.
Nutritional practices and their relationship to clinical outcomes in critically ill children--an international multicenter cohort study*.Crit Care Med. 2012 Jul;40(7):2204-11. doi: 10.1097/CCM.0b013e31824e18a8. Crit Care Med. 2012. PMID: 22564954 Free PMC article. Clinical Trial.
Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults.N Engl J Med. 2015 Jun 18;372(25):2398-408. doi: 10.1056/NEJMoa1502826. Epub 2015 May 20. N Engl J Med. 2015. PMID: 25992505 Clinical Trial.
Effect of hypocaloric normoprotein or trophic feeding versus target full enteral feeding on patient outcomes in critically ill adults: a systematic review.Anaesth Intensive Care. 2017 Nov;45(6):663-675. doi: 10.1177/0310057X1704500604. Anaesth Intensive Care. 2017. PMID: 29137575 Review.
Effects of not monitoring gastric residual volume in intensive care patients: A meta-analysis.Int J Nurs Stud. 2019 Mar;91:86-93. doi: 10.1016/j.ijnurstu.2018.11.005. Epub 2019 Jan 3. Int J Nurs Stud. 2019. PMID: 30677592 Review.