Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study

Table 1 Admission characteristics and outcome data

	All	Before	After	P-value (before vs after)
Admission characteristics
n of pt	480	231	249
Male gender, n (%)	298 (62.1)	151 (65.4)	147 (59.0)	0.159
Surgical profile, n (%)	256 (53.3)	120 (51.9)	136 (54.6)	0.311
Abdominal surgery, n (%)	141 (29.4)	72 (31.2)	69 (27.7)	0.232
Age, mean (range)	61.7 (18-96)	61.5 (18-96)	62.0 (20-93)	0.684
BMI	27.8 (24.3-31.6)	27.7 (24.5-31.5)	27.8 (24.3-32.0)	0.791
APACHE II, points	16 (11.0-22.0)	16 (11.0-21.0)	16 (12.0-22.0)	0.948
SOFA, points	8 (6.0-10.0)	8 (6.0-10.0)	8 (7.0-10.0)	0.504
Vasopressor/inotrope, n (%)	407 (84.8)	195 (84.4)	212 (85.1)	0.462
Mechanical ventilation, n (%)	431 (89.8)	215 (93.1)	216 (86.7)	0.021
Outcomes
ICU stay (d)	13 (9-21)	13 (9-22)	13 (8-21)	0.978
Mechanical ventilation (d)	10 (6-17)	9 (6-18)	10 (6-17)	0.796
Ventilator pneumonia, n (%)	16 (3.3)	7 (3.0)	9 (3.6)	0.461
Urinary tract infection, n (%)	31 (6.5)	16 (6.9)	15 (6.0)	0.582
Bloodstream infection, n (%)	16 (3.3)	6 (2.6)	10 (4.0)	0.404
Cl difficile colitis, n (%)	14 (2.9)	6 (2.6)	8 (3.2)	0.450
ICU mortality	51 (10.6)	28 (12.1)	23 (9.2)	0.190
30-d mortality	121 (25.2)	64 (27.7)	52 (22.9)	0.134
60-d mortality	136 (28.3)	73 (31.6)	63 (25.3)	0.076
90-d mortality	157 (32.7)	86 (37.2)	71 (28.5)	0.026
120-d mortality	164 (34.2)	89 (38.5)	75 (30.1)	0.033

BMI: Body mass index; APACHE II: Acute Physiology and Chronic Health Evaluation II; SOFA: Sequential Organ Failure Assessment; ICU: Intensive care unit.

Table 2 Daily enteral caloric intake

Daily enteral caloric intake	Before	After	P-value
	Median (IQR), kcal	Median (IQR), kcal
Day 1	0 (0-100)	0 (0-0)	0.016
Day 2	0 (0-480)	100 (0-480)	0.409
Day 3	160 (0-700)	370 (0-767)	0.031
Day 4	340 (0-800)	500 (10-960)	0.003
Day 5	400 (0-1000)	580 (176-1100)	0.142
Day 6	500 (53-1000)	695 (240-1138)	0.003
Day 7	500 (108-1000)	720 (200-1155)	0.018

Table 3 Seven-day cumulative enteral and parenteral caloric intake

Cumulative caloric intake	All	Before	After	P-value
	Median (IQR), kcal	Median (IQR), kcal	Median (IQR), kcal	(before vs after)
Cumulative EN calories day 7	2870 (803-5163)	2300 (380-5030)	3210 (1280-5215)	0.049
Cumulative PN calories day 7	3100 (1338-5225)	3977 (1775-6646)	2600 (825-4287)	< 0.001
Cumulative total calories day 7	6531 (5035-8140)	7030 (5667-8970)	6000 (4715-7498)	< 0.001

EN: Enteral feeding; PN: Parenteral nutrition.

Table 4 Regression analysis with day of admission variables predicting insufficient enteral feeding by day 4 and day 7

Variables predicting insufficient EN	Day 4		Day 7
	OR (95%CI)	P-value	OR (95%CI)	P-value
Before group	4.02 (1.55-10.40)	0.004	2.09 (1.35-3.22)	0.001
Abdominal surgery	3.97 (1.26-12.46)	0.018	3.09 (1.82-5.27)	< 0.001
Sum of GI symptoms	6.01 (2.55-14.14)	< 0.001	2.35 (1.60-3.44)	< 0.001
IAH	4.20 (1.32-13.34)	0.015	-	-
Nagelkerke R Square	0.349		0.19

EN: Enteral feeding; GI: Gastrointestinal; IAH: Intra-abdominal hypertensio.