1-3 ; The Impact of Implementation of ICU EN Protocol on the Improvement in Enteral Nutrition Practice = 1-3 ; The Impact of Implementation of ICU EN Protocol on the Improvement in Enteral Nutrition Practice

다국어 초록 (Multilingual Abstract)

Background: Optimal delivery of enteral nutrition (EN) may improve clinical outcomes of critically ill patients and enteral feeding protocols help to improve EN practice. The purpose of this study was to evaluate the impact of implementation of enteral feeding protocol on the improvement in EN practice and on the clinical outcomes of adult critically ill patients. Methods: This was a retrospective cohort study with prospectively collected data. Multidisciplinary working group, including dietitian, nurse, and intensivist, developed the evidence-based protocol by extensive literatures and guideline review. We included the consecutive patients admitted to the medical and surgical ICU and received EN more than 24 hours. The EN practices and clinical outcomes were compared between before and after implementation of enteral feeding protocol. Results: A total of 270 patients were included in this study; 134 patients before implementation, 136 after implementation. Basic clinical characteristics were not different between two phases. Enteral feeding was initiated earlier (35.8 vs 87.1 hours, p=0.001) and more patients received EN within 24 hours (59.6% vs 41.0%, p=0.002) after implementation of protocol. Interval between starting and reaching caloric goal was not different, however more patients reached caloric goal after implementation (52.2% vs 38.3%, p=0.037). Post-implementation group used more prokinetics (53.7% vs 34.3%. p=0.001) and less parenteral nutrition. Diarrhea and gastrointestinal bleeding were significantly decreased after implementation. There was no difference in clinical outcomes including ICU death, ICU free day, and hospital day. Conclusion: The implementation of enteral feeding protocol significantly improved the practices of EN and decrease complications in critically ill patients. The clinical outcomes were not different before and after implementation.