Division of Human Nutrition, Faculty of Agriculture, Life, and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada.
Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
JPEN J Parenter Enteral Nutr. 2018 Feb;42(2):327-334. doi: 10.1177/0148607117692751. Epub 2017 Dec 12.
Patients admitted to pediatric intensive care units (PICUs) often experience prolonged periods without nutrition support, which may result in hospital-induced malnutrition and longer length of stay. Nurse-driven feeding protocols have been developed to prevent unnecessary interruptions or delays to nutrition support. The primary objective of this study was to identify compliance and reasons for noncompliance to a feeding protocol at a tertiary care hospital PICU in Canada. The secondary aim was to determine the mean time (hours) spent without any form of nutrition and to identify reasons for time spent without nutrition.
This was a prospective cohort audit, consisting of 150 consecutive PICU admissions (January-February 2016). Exclusion criteria consisted of patient mortality within 48 hours (n = 1) and patients who were still admitted at the end of the data collection timeframe (n = 7). The remaining cohort consisted of 142 consecutive admissions. Data collection took place in real time and included patient demographics, diagnostic categories, time spent without nutrition, reasons for interruptions to nutrition support, and reasons for noncompliance to the protocol. Observations were obtained through paper and computer charts and conversing with clinicians.
There was a 95% compliance rate to the protocol and an average of 25.6 hours spent without nutrition per patient. The most prevalent reason for noncompliance was an avoidable delay to restart feeds before/after procedures or after surgery.
A nurse-driven feeding protocol may reduce time spent without nutrition. Future research is required to examine the relationship between adherence to feeding protocols and clinical outcomes.
入住儿科重症监护病房（PICU）的患者常经历长时间无营养支持，这可能导致医院相关性营养不良和住院时间延长。已制定护士主导的喂养方案以预防营养支持的不必要中断或延迟。本研究的主要目的是确定加拿大一家三级护理医院 PICU 喂养方案的依从性和不依从的原因。次要目的是确定无任何形式营养的平均时间（小时），并确定无营养的原因。
这是一项前瞻性队列研究，纳入了 150 例连续 PICU 入院患者（2016 年 1 月至 2 月）。排除标准为入院后 48 小时内死亡的患者（n=1）和数据收集结束时仍住院的患者（n=7）。剩余队列由 142 例连续入院患者组成。数据实时收集，包括患者人口统计学、诊断类别、无营养时间、营养支持中断的原因以及对方案的不依从原因。通过纸质和计算机图表以及与临床医生交谈获得观察结果。
方案的依从率为 95%，每位患者平均有 25.6 小时无营养。最常见的不依从原因是手术前后程序或手术后可避免的重新开始喂养的延迟。
护士主导的喂养方案可减少无营养时间。需要进一步研究以检查喂养方案的依从性与临床结局之间的关系。
