Enteral Nutrition in Critically Ill Patients: The ENCIP Study

Abstract

Background: Underfeeding is prevalent in intensive care units (ICU), which has been associated with poor clinical outcomes. As a result, feeding protocols have been developed to help improve the efficacy of enteral nutrition (EN) delivery in critically ill patients. Aim: The study aimed to assess the adequacy of EN provision in an ICU, following a local feeding protocol. In addition, investigated if the local protocol enabled an association with ICU and hospital length of stay (LOS) and mortality (ICU, hospital and 28-days). Methods: A prospective observational study was conducted from October 2016 to February 2017, recruiting ICU patients (>18 years) exclusively EN fed ≥ 24 hours up to 12 ICU days. The main exposure was nutritional adequacy (defined as meeting 80% energy and protein requirements). The primary outcome was adherence of the protocol evaluated through 5 domains: monitoring, prescription, adjustment and referral. Secondary outcomes included ICU and hospital LOS, and ICU, hospital and 28-day mortality. Results: A total of 42 medical and surgical patients were included in this study. Only a small proportion (19%) of patients met nutritional adequacy. Evaluation of the protocol provided insights pertaining to the possible reasons for underfeeding, including the slow progression of feeding rates due to low adherence to EN rate changes adjusted appropriately and frequent EN interruptions. No associations were found between hospital- and 28-day mortality and nutritional adequacy. Conclusion: Nutritional adequacy was assessed in this study population and the results from the protocol adherence highlighted potential reasons for underfeeding in this study sample.

Date of Award	31 May 2017
Original language	English
Supervisor	Ra'eesa Doola (Supervisor), Debbie Tolcher (Supervisor) & Barbara S Van der Meij (Supervisor)