Wilson Sara, Madisi Nagendra Y, Bassily-Marcus Adel, Manasia Anthony, Oropello John, Kohli-Seth Roopa
Sara Wilson, Department of Clinical Nutrition, Mount Sinai Hospital, New York, NY 10129, United States.
World J Crit Care Med. 2016 Aug 4;5(3):180-6. doi: 10.5492/wjccm.v5.i3.180.
To evaluate the impact of an enteral feeding protocol on administration of nutrition to surgical intensive care unit (SICU) patients.
A retrospective chart review was conducted on patients initiated on enteral nutrition (EN) support during their stay in a 14 bed SICU. Data collected over a seven-day period included date of tube feed initiation, rate initiated, subsequent hourly rates, volume provided daily, and the nature and length of interruptions. The six months prior to implementation of the feeding protocol (pre-intervention) and six months after implementation (post-intervention) were compared. One hundred and four patients met criteria for inclusion; 53 were pre-intervention and 51 post-intervention.
Of the 624 patients who received nutrition support during the review period, 104 met the criteria for inclusion in the study. Of the 104 patients who met criteria outlined for inclusion, 64 reached the calculated goal rate (pre = 28 and post = 36). The median time to achieve the goal rate was significantly shorter in the post-intervention phase (3 d vs 6 d; P = 0.01). The time to achieve the total recommended daily volume showed a non-significant decline in the post-intervention phase (P = 0.24) and the overall volume administered daily was higher in the post-intervention phase (61.6% vs 53.5%; P = 0.07). While the overall interruptions data did not reach statistical significance, undocumented interruptions (interruptions for unknown reasons) were lower in the post-intervention phase (pre = 23/124, post = 9/96; P = 0.06).
A protocol delineating the initiation and advancement of EN support coupled with ongoing education can improve administration of nutrition to SICU patients.
评估肠内营养方案对外科重症监护病房（SICU）患者营养供给的影响。
对入住拥有14张床位的SICU期间开始接受肠内营养（EN）支持的患者进行回顾性病历审查。在七天时间内收集的数据包括管饲开始日期、起始速率、随后的每小时速率、每日提供的量以及中断的性质和时长。对实施喂养方案前的六个月（干预前）和实施后的六个月（干预后）进行比较。104名患者符合纳入标准；53名处于干预前，51名处于干预后。
在审查期间接受营养支持的624名患者中，104名符合纳入本研究的标准。在符合纳入标准的104名患者中，64名达到了计算出的目标速率（干预前 = 28名，干预后 = 36名）。在干预后阶段达到目标速率的中位时间显著更短（3天对6天；P = 0.01）。达到每日推荐总量的时间在干预后阶段呈非显著性下降（P = 0.24），且干预后阶段每日给予的总量更高（61.6%对53.5%；P = 0.07）。虽然总体中断数据未达到统计学显著性，但干预后阶段未记录的中断（原因不明的中断）较少（干预前 = 23/124，干预后 = 9/96；P = 0.06）。
一份规定EN支持起始和推进的方案，再加上持续教育，可改善对SICU患者的营养供给。
