Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Aug 4, 2016; 5(3): 180-186
Published online Aug 4, 2016. doi: 10.5492/wjccm.v5.i3.180
Enteral nutrition administration in a surgical intensive care unit: Achieving goals with better strategies
Sara Wilson, Nagendra Y Madisi, Adel Bassily-Marcus, Anthony Manasia, John Oropello, Roopa Kohli-Seth
Sara Wilson, Department of Clinical Nutrition, Mount Sinai Hospital, New York, NY 10129, United States
Nagendra Y Madisi, Adel Bassily-Marcus, Anthony Manasia, John Oropello, Roopa Kohli-Seth, Division of Surgical Critical Care Medicine, Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY 10129, United States
Author contributions: Wilson S, Madisi NY and Kohli-Seth R contributed equally to this work; Wilson S helped in the acquisition of the data; Wilson S, Madisi NY and Kohli-Seth R analyzed, interpreted the data and drafted the manuscript; Bassily-Marcus A, Manasia A and Oropello J provided analytical oversight, revised the manuscript and material support; Kohli-Seth R contributed to the conception and design of the study, supervised the study and provided administrative support; all authors have read and approved the final version to be published.
Institutional review board statement: The study was reviewed and approved by Icahn School of Medicine at Mt Sinai Institutional Review Board.
Informed consent statement: Waiver of informed consent was provided by Icahn School of Medicine at Mt Sinai Institutional Review Board.
Conflict-of-interest statement: All the authors involved in the study have no conflict of interest to declare.
Data sharing statement: Data is available from the corresponding author - nagendra.madisi@mountsinai.org.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Nagendra Y Madisi, MD, Critical Care Fellow, Division of Surgical Critical Care Medicine, Department of Surgery, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1264, New York, NY 10029, United States. nagendra.madisi@mountsinai.org
Telephone: +1-443-2207373
Received: February 24, 2016
Peer-review started: February 27, 2016
First decision: April 15, 2016
Revised: May 2, 2016
Accepted: June 1, 2016
Article in press: June 3, 2016
Published online: August 4, 2016
Processing time: 160 Days and 10.1 Hours
Abstract

AIM: To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit (SICU) patients.

METHODS: A retrospective chart review was conducted on patients initiated on enteral nutrition (EN) support during their stay in a 14 bed SICU. Data collected over a seven-day period included date of tube feed initiation, rate initiated, subsequent hourly rates, volume provided daily, and the nature and length of interruptions. The six months prior to implementation of the feeding protocol (pre-intervention) and six months after implementation (post-intervention) were compared. One hundred and four patients met criteria for inclusion; 53 were pre-intervention and 51 post-intervention.

RESULTS: Of the 624 patients who received nutrition support during the review period, 104 met the criteria for inclusion in the study. Of the 104 patients who met criteria outlined for inclusion, 64 reached the calculated goal rate (pre = 28 and post = 36). The median time to achieve the goal rate was significantly shorter in the post-intervention phase (3 d vs 6 d; P = 0.01). The time to achieve the total recommended daily volume showed a non-significant decline in the post-intervention phase (P = 0.24) and the overall volume administered daily was higher in the post-intervention phase (61.6% vs 53.5%; P = 0.07). While the overall interruptions data did not reach statistical significance, undocumented interruptions (interruptions for unknown reasons) were lower in the post-intervention phase (pre = 23/124, post = 9/96; P = 0.06).

CONCLUSION: A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.

Keywords: Enteral nutrition; Surgical critical care; Protocol; Critical care; Nutrition support

Core tip: Surgical critical care patients are more prone to frequent feeding interruptions for unavoidable reasons. In this study we validated that implementation of a feeding protocol in a surgical intensive care unit (SICU) decreased time to achieve goal rate and increased the total volume administered daily, despite frequent interruptions. It also increased detailed documentation by unit staff of interruptions allowing us to identify a trend with regard to feeding interruptions to better understand which practices/procedures require further review. The median time to achieve the goal rate was significantly shorter in the post-intervention phase. The time to achieve the total recommended daily volume showed a non-significant decline in the post-intervention phase and the overall volume administered daily was higher in the post-intervention phase. While the overall interruptions data did not reach statistical significance, undocumented interruptions (interruptions for unknown reasons) were lower in the post-intervention phase. To our knowledge, we are the second largest single center study supporting the benefit of implementing a feeding protocol in a SICU.