To promote the standardization of implementing enteral nutrition in critically ill patients

doi:10.3877/cma.j.issn.2096-1537.2020.04.001

Abstract

Abstract:

Nutritional support plays a major role in the management of critically ill patients, but optimal strategy is unclear. Early enteral nutrition (EN) is frequently recommended in many clinical guidelines. However, practice-evidence gap may affect the implementation of EN, leading to the poor outcomes. Hence, translation of evidence into practice is a key factor to improve the enteral feeding performance. Several studies have demonstrated that feeding protocols could achieve earlier EN, enhance the energy target-reaching rate, and reduce the mortality and the length of hospital stay, but there is no similar evidence-based protocols in China. Therefore, we developed the first EN feeding protocol in China and conducted a multi-center, cluster randomized-controlled study to provide evidence-based practice for EN.

Key words: Enteral nutrition, Critical illness, Feeding protocol

Jiajia Lin, Weiqin Li, Kaijiang Yu. To promote the standardization of implementing enteral nutrition in critically ill patients[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2020, 06(04): 357-360.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2020.04.001

https://icu.cma-cmc.com.cn/EN/Y2020/V06/I04/357

References 35

1	Cuthbertson. Post-shock metabolic response[J]. Lancet, 1942, 239(6189): 433-437.
2	Moore FD. Metabolic care of the surgical patient [J]. Amer J Med Sci, 1959, 240(1): 127.
3	Bistrian BR, Blackburn GL, Vitale J, et al. Prevalence of malnutrition in general medical patients [J]. JAMA, 1976, 235(15): 1567-1570.
4	Barker LA, Gout BS, Crowe TC. Hospital malnutrition: prevalence, identification and impact on patients and the healthcare system [J]. Int J Environ Res Public Health, 2011, 8(2): 514-527.
5	Bistrian BR, Blackburn GL, Hallowell E, et al. Protein status of general surgical patients [J]. JAMA, 1974, 230(6): 858-860.
6	Lim SL, Ong KC, Chan YH, et al. Malnutrition and its impact on cost of hospitalization, length of stay, readmission and 3-year mortality [J]. Clin Nutr, 2012, 31(3): 345-350.
7	Somanchi M, Tao X, Mullin GE. The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition [J]. JPEN J Parenter Enteral Nutr, 2011, 35(2): 209-216.
8	Lew CCH, Yandell R, Fraser RJL, et al. Association between malnutrition and clinical outcomes in the intensive care unit: a systematic review [J]. JPEN J Parenter Enteral Nutr, 2017, 41(5): 744-758.
9	Mcclave SA, Taylor BE, Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) [J]. JPEN J Parenter Enteral Nutr, 2016, 40(2): 159-211.
10	Allaudeen N, Vidyarthi A, Maselli J, et al. Redefining readmission risk factors for general medicine patients [J]. J Hosp Med, 2011, 6(2): 54-60.
11	Artinian V, Krayem H, Digiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients [J]. Chest, 2006, 129(4): 960-967.
12	Berger MM, Chiolero RL. Hypocaloric feeding: pros and cons [J]. Curr Opin Crit Care, 2007, 13(2): 180-186.
13	Tyler R, Barrocas A, Guenter P, et al. Value of nutrition support therapy: impact on clinical and economic outcomes in the United States [J]. JPEN J Parenter Enteral Nutr, 2020, 44(3): 395-406.
14	Singer P, Anbar R, Cohen J, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients [J]. Intensive Care Med, 2011, 37(4): 601-609.
15	Alberda C, Gramlich L, Jones N, et al. The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study [J]. Intensive Care Med, 2009, 35(10): 1728-1737.
16	Wei X, Day AG, Ouellette-Kuntz H, et al. The association between nutritional adequacy and long-term outcomes in critically ill patients requiring prolonged mechanical ventilation: a multicenter cohort study [J]. Crit Care Med, 2015, 43(8): 1569-1579.
17	Taylor SJ, Fettes SB, Jewkes C, et al. Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury [J]. Crit Care Med, 1999, 27(11): 2525-2531.
18	Heyland DK, Stephens KE, Day AG, et al. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study [J]. Clin Nutr, 2011, 30(2): 148-155.
19	Elke G, Wang M, Weiler N, et al. Close to recommended caloric and protein intake by enteral nutrition is associated with better clinical outcome of critically ill septic patients: secondary analysis of a large international nutrition database [J]. Crit Care, 2014, 18(1): R29.
20	Singer P. Preserving the quality of life: nutrition in the ICU [J]. Crit Care, 2019, 23(Suppl 1): 139.
21	Gramlich L, Kichian K, Pinilla J, et al. Does enteral nutrition compared to parenteral nutrition result in better outcomes in critically ill adult patients? A systematic review of the literature [J]. Nutrition, 2004, 20(10): 843-848.
22	Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review [J]. Crit Care Med, 2001, 29(12): 2264-2270.
23	Kudsk KA, Minard G, Croce MA, et al. A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhancing diet reduces septic complications [J]. Ann Surg, 1996, 224(4): 531-540; discussion 40-43.
24	Pu H, Doig GS, Heighes PT, et al. Early enteral nutrition reduces mortality and improves other key outcomes in patients with major burn injury: a meta-analysis of randomized controlled trials [J]. Crit Care Med, 2018, 46(12): 2036-2042.
25	Chourdakis M, Kraus MM, Tzellos T, et al. Effect of early compared with delayed enteral nutrition on endocrine function in patients with traumatic brain injury: an open-labeled randomized trial [J]. JPEN J Parenter Enteral Nutr, 2012, 36(1): 108-116.
26	Windsor AC, Kanwar S, Li AG, et al. Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis [J]. Gut, 1998, 42(3): 431-435.
27	Bendavid I, Singer P, Theilla M, et al. NutritionDay ICU: a 7 year worldwide prevalence study of nutrition practice in intensive care [J]. Clin Nutr, 2017, 36(4): 1122-1129.
28	Cahill NE, Dhaliwal R, Day AG, et al. Nutrition therapy in the critical care setting: what is "best achievable" practice? An international multicenter observational study [J]. Crit Care Med, 2010, 38(2): 395-401.
29	Xing J, Zhang Z, Ke L, et al. Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals [J]. Crit Care, 2018, 22(1): 229.
30	Schuster MA, Mcglynn EA, Brook RH. How good is the quality of health care in the United States? [J]. Milbank Q, 1998, 76(4): 517-563, 609.
31	Buchan H. Gaps between best evidence and practice: causes for concern [J]. Med J Aust, 2004, 180(S6): S48-49.
32	Martin CM, Doig GS, Heyland DK, et al. Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT) [J]. CMAJ, 2004, 170(2): 197-204.
33	Doig GS, Simpson F, Finfer S, et al. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial [J]. JAMA, 2008, 300(23): 2731-2741.
34	Barr J, Hecht M, Flavin KE, et al. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol [J]. Chest, 2004, 125(4): 1446-1457.
35	Li Q, Zhang Z, Xie B, et al. Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study [J]. PLoS One, 2017, 12(8): e0182393.

[1]	Zhudan Yin, Yu Wang, Ke Zhen, Bin Xu, Yali Tian, Zirong Tong. Effect of early hypocaloric enteral nutrition support on prognosis in critically ill patients: a meta-analysis [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(03): 215-222.
[2]	Xiaoli Miao, Jilu Ye, Xuehua Pu, Bin Hou, Zhixiang Shi, Jin Zhu, Zhilin Gu. Effect of enteral nutrition with pectin dietary fiber on immune and gastrointestinal functions in severe patients [J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2021, 14(06): 460-465.
[3]	Ping Yang, Shimin Xu, Liangliang Li, Xiangyun Yin, Hongmin Xi, Lili Ma, Xianghong Li. Influencing factors of bronchopulmonary dysplasia complicated with metabolic bone disease in preterm infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(02): 202-211.
[4]	Jiali Li, Yang Wu, Li Zhang, Bin Xia, Yang He, Zhong Chen, Jun Tang, Dezhi Mu. Clinical characteristics and outcomes of neonatal gastrointestinal perforation [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2022, 18(06): 703-711.
[5]	Lijuan Long, Hongjuan Bi, Yisi Huang, Qiufen Wei, Liping Yao. Analysis of clinical characteristics of parenteral nutrition associated cholestasis in very/extremely low birth weight infants [J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2021, 17(05): 545-551.
[6]	Cuijun Huang, Xiling Zhang, Sijia Liu, Yunjian Liu. Research progress in nutritional support therapy for severe acute pancreatitis [J]. Chinese Archives of General Surgery(Electronic Edition), 2023, 17(05): 385-390.
[7]	Huizhong Niu, Feng Liu, Pengju Zhang, Jianlei Geng, Hui Ren. Effect of transnasal indwelling jejunal nutrition tube in the treatment of high intestinal obstruction operation for the newborns [J]. Chinese Archives of General Surgery(Electronic Edition), 2021, 15(06): 437-441.
[8]	Shizhou Liu, Jiarou Yao, Shaojian Mo. Research progress of nutritional support in severe acute pancreatitis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(05): 533-535.
[9]	Tongjuan Zou, Wanhong Yin, Wei He, Yuan Xu, Xiaolin Ai, Ya Li. Advantages and pitfalls of bedside ultrasound-guided enteral nutrition implementation [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 313-320.
[10]	Chuanxi Chen, Bin Ouyang. Assessment and monitoring enteral nutrition in hemodynamically unstable ICU patients [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 310-312.
[11]	Jianbo Li, Wanhong Yin, Tongjuan Zou, Yuan Xu, Wei He. Feeding intolerance: how to define? [J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(04): 299-303.
[12]	Guoying Gu, Yingchun Huang, Jia Liu, Jianming Ju, Guofeng Yu, Rong Jiang. Application of individualized parenteral nutrition in patients with intestinal resection and intestinal dysfunction [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(06): 489-493.
[13]	Yingzhi Wang, Xianjin Zhang, Shiyan Yang. Effects of probiotics combined with early enteral nutrition on nutritional status, intestinal mucosal barrier function and enteral nutrition tolerance in patients with severe acute pancreatitis [J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2023, 13(01): 55-58.
[14]	Yi Zhou, Jing He, Hongsuo Chen, Shuixia Li, Xianmei Meng, Tong Dang. The clinical effect of enteral nutrition support intervention in patients with actue pancreatitis and its influence on nutritional status [J]. Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition), 2022, 09(03): 126-129.
[15]	Hongjie Tong, Feiyan Pan, Xing Shao, Xiaoling Zhang, Hongying Ni, Kun Chen. Risk factors of bone loss in elderly patients with critical illness [J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2022, 09(02): 22-26.

Please choose a citation manager

Content to export