Department of Nutrition and Dietetics, Royal Brisbane & Women's Hospital, Brisbane, QLD.
Crit Care Resusc. 2010 Sep;12(3):149-55.
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).
A detailed feeding algorithm that included commencement of nutrition support, progression to goal nutrition rates and management of gastric residual volumes.
Time to commencement of nutrition support; time to reach goal nutrition rate; nutritional adequacy over ICU stay.
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.
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.
确定详细的喂养算法是否优于标准喂养方案，从而改善危重症患者的营养支持。
设计、地点和参与者：在接受肠内或肠外营养的重症监护病房患者中，进行了干预前和干预后的比较，这些患者的入住时间（ LOS ）超过 30 天，恢复口服摄入，患者从 ICU 出院或患者死亡。该研究于 2005 年（干预前）和 2007 年（干预后）在布里斯班皇家妇女医院进行，这是一家拥有 27 张 ICU 床位的三级医院。
详细的喂养算法，包括营养支持的开始、向目标营养速率的进展以及胃残留量的管理。
营养支持开始的时间；达到目标营养率的时间； ICU 期间的营养充足程度。
在干预前（ n = 42 ）和实施后（ n = 41 ）患者组之间没有观察到人口统计学差异。详细喂养算法的实施将开始营养支持的平均时间从 28 小时缩短至 16 小时（ P = 0.035 ）。达到目标营养率的时间从 22 小时缩短至 13 小时，但差异无统计学意义。在达到 ICU 入院期间目标量的患者数量方面，干预前和干预后组之间没有显著差异。中断是达到肠内喂养目标量的主要障碍。
引入详细的喂养算法可更早开始营养支持，并在更短的时间内使更多的患者达到目标率。为了提高营养充足度，需要修改算法以考虑 ICU 期间不可避免的中断。
