Objective: To determine whether a detailed feeding algorithm improved nutrition support of critically ill patients compared with a standard feeding protocol.
Design, setting and participants: Pre- and post-intervention comparison of nutrition commencement and nutritional adequacy in intensive care unit patients receiving enteral or parenteral nutrition until length of stay (LOS) exceeded 30 days, oral intake resumed, the patient was discharged from the ICU or the patient died. The study was conducted at the Royal Brisbane & Women's Hospital, a tertiary hospital with 27 ICU beds, in 2005 (pre-intervention) and 2007 (post-intervention).
Intervention: A detailed feeding algorithm that included commencement of nutrition support, progression to goal nutrition rates and management of gastric residual volumes.
Main outcome measures: Time to commencement of nutrition support; time to reach goal nutrition rate; nutritional adequacy over ICU stay.
Results: No demographic differences between pre- (n=42) and post-implementation (n=41) patient groups were observed. Implementation of the detailed feeding algorithm reduced the mean time to commence nutrition support from 28 hours to 16 hours (P=0.035). Time to reach goal nutrition rate fell from 22 hours to 13 hours, although the difference was not statistically significant. There was no significant difference between pre- and post-implementation groups in the number of patients reaching goal volume during ICU admission. Interruptions were a major obstacle to goal volumes of enteral feeds being reached.
Conclusions: Introduction of a detailed feeding algorithm resulted in earlier commencement of nutrition support and increased numbers of patients reaching goal rates in less time. To improve nutritional adequacy, the algorithm needs to be modified to account for unavoidable interruptions during ICU stay.