JPEN. Journal of parenteral and enteral nutrition | 2021
Prospective Evaluation of a Novel Enteral Feeding Guideline Based on Individual Gastric Emptying Times: An Improvement Project in a Pediatric Intensive Care Unit (PICU).
Abstract
BACKGROUND\nOn a 20-bed mixed cardiac and general UK PICU, we aimed to determine if a physiologically-based enteral feeding guideline for critically ill children, using feed frequency tailored to individual gastric emptying times (GETs), resulted in: earlier establishment of full feeds (being when 100% of fluid allowance available to be given as intravenous maintenance fluid or feed, defined as Free Fluid Allowance (FFA), is given as enteral nutrition (EN)); and an increase in FFA given as EN.\n\n\nMETHODS\nFour prospective audits (totaling 331 patients, 19,771 hours) were conducted at one year prior to guideline introduction and one/five/ten years after. Patient feeding data were collected from admission until day 4 or discharge, including reasons why feed was withheld.\n\n\nRESULTS\nThe median time from admission to establishing full feeds decreased from 18 to 10 hours pre- and post-guideline; and was sustained over 10 years. After adjustment for five confounders, this represented a reduction in the geometric mean time to full feeds of 30% (2009), 29% (2013) and 48% (2019) compared to 2007, all P<0.01. Nil-per-oral (NPO) hours were categorized as due to modifiable and non-modifiable factors. Pre- and post-guideline, NPO-hours from modifiable factors decreased from 21 (2007) to 10 (2009) per 100 audit hours, which was sustained across 10 years (all P<0.01). Conversely, NPO-hours from non-modifiable factors ranged from 27 to 36 per 100 audit hours throughout the audits, with no consistent trend over time. Similar inconsistency was shown in the proportion of FFA given as EN: 48% (2007); 71% (2009); 51% (2013); and 64% (2019). Continuous nasogastric and hourly bolus feeds decreased over time; they comprised 66% of feeds in 2007, but only 4-11% in subsequent periods being replaced with more 2-6hourly bolus, on demand or continuous nasojejunal feeds.\n\n\nCONCLUSIONS\nThe guideline was associated with: sustained reduction in the time to establishing full feeds and NPO-hours due to modifiable factors; and more or no less FFA being given as EN. This article is protected by copyright. All rights reserved.