Sng Qian Wen, Ong Chengsi, Ang Su Ling Linda, Kirk Angela Hui Ping, Lee Jan Hau
Division of Nursing, KK Women's and Children's Hospital, Singapore.
Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore.
Pediatr Qual Saf. 2020 Jan 12;5(1):e249. doi: 10.1097/pq9.0000000000000249. eCollection 2020 Jan-Feb.
Strategies to improve nutritional management are associated with better outcomes in pediatric intensive care units. We implemented a calorie-based protocol that integrated an electronic feeds calculator and stepwise feeds increment algorithm.
Using a pretest-posttest design, we compared the effectiveness of the calorie-based protocol with an existing fluid-based protocol in a quality improvement project. The main outcome measure was the proportion of patients prescribed with the appropriate amount of calories (defined as 90%-110% of calculated energy requirements). Nurses were surveyed on their satisfaction with the new calorie-based protocol. We compared consecutive patients enrolled in the calorie-based protocol over 21 months with retrospective data of patients in the fluid-based protocol. and Mann-Whitney U tests were used to compare categorical and continuous variables, respectively.
We enrolled 75 and 92 patients in the fluid-based (pre) and calorie-based (post) protocols, respectively. Both groups did not differ in their age, reasons for pediatric intensive care units admissions, length of stay, duration of mechanical ventilation, and risks of mortality. The frequency of appropriate feeds prescription increased (16.0% versus 33.7%, = 0.002). The new protocol significantly reduced the time from protocol initiation to full feeds (median: 18.0 hours, interquartile range = 18.0-27.5 versus median: 12.8 hours, interquartile range = 12.0-16.0, < 0.001). The satisfaction surveys (n = 63) revealed favorable nursing perceptions.
The use of a calorie-based protocol with an electronic calculator led to an improvement in the accuracy of the prescribed feeds and the time required to attain full enteral feeding. Nursing perceptions regarding the protocol were positive.
改善营养管理的策略与儿科重症监护病房更好的治疗效果相关。我们实施了一项基于卡路里的方案，该方案整合了电子喂养计算器和逐步增加喂养量的算法。
在一项质量改进项目中，我们采用前后测试设计，比较了基于卡路里的方案与现有的基于液体的方案的有效性。主要结局指标是接受适当卡路里量（定义为计算出的能量需求的90%-110%）的患者比例。对护士进行了关于他们对新的基于卡路里的方案满意度的调查。我们将21个月内纳入基于卡路里方案的连续患者与基于液体方案患者的回顾性数据进行了比较。分别使用卡方检验和曼-惠特尼U检验来比较分类变量和连续变量。
我们分别将75例和92例患者纳入基于液体的（前）方案和基于卡路里的（后）方案。两组在年龄、儿科重症监护病房入院原因、住院时间、机械通气持续时间和死亡风险方面没有差异。适当喂养处方的频率增加了（16.0%对33.7%，P = 0.002）。新方案显著缩短了从方案启动到完全喂养的时间（中位数：18.0小时，四分位间距 = 18.0 - 27.5对中位数：12.8小时，四分位间距 = 12.0 - 16.0，P < 0.001）。满意度调查（n = 63）显示护士的看法良好。
使用带有电子计算器的基于卡路里的方案可提高规定喂养的准确性以及实现完全肠内喂养所需的时间。护士对该方案的看法是积极的。
