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Nutrients 2017, 9(5), 527; doi:10.3390/nu9050527

Optimal Energy Delivery, Rather than the Implementation of a Feeding Protocol, May Benefit Clinical Outcomes in Critically Ill Patients

1
Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
2
Department of Nursing, Hung Kuang University, Taichung 43302, Taiwan
3
Department of Food and Nutrition, Taichung Veterans General Hospital, Taichung 40705, Taiwan
4
Department of Nursing, Taichung Veterans General Hospital, Taichung 40705, Taiwan
5
Department of Nutrition, Chung Shan Medical University, Taichung 40201, Taiwan
6
Department of Nutrition, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
*
Author to whom correspondence should be addressed.
Received: 18 April 2017 / Revised: 15 May 2017 / Accepted: 18 May 2017 / Published: 21 May 2017
(This article belongs to the Special Issue Nutritional Approach to Critically Ill Patients)
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Abstract

Malnutrition is common in intensive care units (ICU), and volume based feeding protocols have been proposed to increase nutrient delivery. However, the volume based approach compared to trophic feeding has not been proven entirely successful in critically ill patients. Our study aimed to compare the clinical outcomes both before and after the implementation of the feeding protocol, and to also evaluate the effects of total energy delivery on outcomes in these patients. We retrospectively collected all patient data, one year before and after the implementation of the volume-based feeding protocol, in the ICU at Taichung Veterans General Hospital. Daily actual energy intake from enteral nutritional support was recorded from the day of ICU admission until either the 7th day of ICU stay, or the day of discharge from the ICU. The energy achievement rate (%) was calculated as: (actual energy intake/estimated energy requirement) × 100%. Two-hundred fourteen patients were enrolled before the implementation of the volume-based feeding protocol (pre-FP group), while 198 patients were enrolled after the implementation of the volume-based feeding protocol (FP group). Although patients in the FP group had significantly higher actual energy intakes and achievement rates when compared with the patients in the pre-FP group, there was no significant difference in mortality rate between the two groups. Comparing survivors and non-survivors from both groups, an energy achievement rate of less than 65% was associated with an increased mortality rate after adjusting for potential confounders (odds ratio, 1.6, 95% confidence interval, 1.01–2.47). The implementation of the feeding protocol could improve energy intake for critically ill patients, however it had no beneficial effects on reducing the ICU mortality rate. Receiving at least 65% of their energy requirements is the main key point for improving clinical outcomes in patients. View Full-Text
Keywords: energy delivery; feeding protocol; clinical outcomes; critically ill patients energy delivery; feeding protocol; clinical outcomes; critically ill patients
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Wang, C.-Y.; Huang, C.-T.; Chen, C.-H.; Chen, M.-F.; Ching, S.-L.; Huang, Y.-C. Optimal Energy Delivery, Rather than the Implementation of a Feeding Protocol, May Benefit Clinical Outcomes in Critically Ill Patients. Nutrients 2017, 9, 527.

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