Department of Nutrition and Dietetics, Southmead Hospital, Bristol, United Kingdom.
Institute of Health and Community, University of Plymouth, Peninsula Allied Health Centre, Plymouth, Devon, United Kingdom.
Nutr Clin Pract. 2019 Feb;34(1):123-130. doi: 10.1002/ncp.10209. Epub 2018 Nov 19.
In a previous audit, 81% of enteral protein prescriptions failed to meet protein guidelines. To address this, a very high-protein enteral formula and protein supplements were introduced, and protein prescriptions were adjusted to account for nonnutrition energy sources displacing enteral formula. This follow-up audit compared protein provision in critically ill adults requiring exclusive enteral nutrition (EN), first, with local and international guidelines, and second, after changes to practice, with the previous audit in the same intensive care unit (ICU).
Data were collected from 106 adults consecutively admitted to the ICU of a U.K. tertiary hospital and requiring exclusive EN ≥3 days. Protein targets based on local guidelines (1.25, 1.5, or 2.0 g/kg/d), nutrition prescription, and delivery were recorded for 24 hours between days 1-3, 5-7, 8-10, and 18-20 post-ICU admission.
The proportion of day 1-3 protein prescriptions meeting protein targets increased from 19% in 2015 to 69% in 2017 (P < .0005, φ = 0.50). The median percentage of protein target delivered was lower than prescribed (79% vs 103%; (P < .0005; r = 0.53) and EN delivery only met the target of 22% of patients. The proportion of protein prescriptions meeting protein targets was similar for days 1-3 (69%), 5-7 (71%), and 8-10 (68%), but increased slightly by days 18-20 (74%). The proportion of patients for which EN delivery met protein targets increased with the number of days post-ICU admission (22%, 26%, 37%, and 53% for days 1-3, 5-7, 8-10, and 18-20, respectively).
The proportion of protein prescriptions meeting guideline targets was higher after changes to practice.
在之前的审核中，81%的肠内蛋白质处方未达到蛋白质指南的要求。为了解决这个问题，引入了一种高蛋白肠内配方和蛋白质补充剂，并调整了蛋白质处方，以考虑非营养能量源替代肠内配方。此次后续审核首先比较了英国一家三级医院重症监护病房（ICU）中需要完全肠内营养（EN）的成年患者的蛋白质供应情况，与当地和国际指南进行比较，其次与同一 ICU 之前的审核进行比较。
从连续入住英国一家三级医院 ICU 并需要完全 EN ≥3 天的 106 名成人中收集数据。记录患者 ICU 入院后第 1-3、5-7、8-10 和 18-20 天的 24 小时内的蛋白质目标（基于当地指南的 1.25、1.5 或 2.0 g/kg/d）、营养处方和输送情况。
第 1-3 天的蛋白质处方符合蛋白质目标的比例从 2015 年的 19%增加到 2017 年的 69%（P<0.0005，φ=0.50）。实际输送的蛋白质百分比低于规定的百分比（79%比 103%；（P<0.0005；r=0.53），只有 22%的患者接受了 EN 治疗。第 1-3、5-7 和 8-10 天的蛋白质处方符合蛋白质目标的比例相似，但第 18-20 天略有增加（69%）。符合蛋白质目标的患者比例随着 ICU 后天数的增加而增加（第 1-3、5-7、8-10 和 18-20 天分别为 22%、26%、37%和 53%）。
实践改变后，符合指南目标的蛋白质处方比例更高。
