Mauricio Ferri, MD; Neill Adhikari, MD, MSc
Does implementation of an evidence-based nutritional support guideline improve feeding practices and reduce mortality in patients in intensive care units (ICUs)?
Cluster-randomized controlled trial. Australian New Zealand Trials Registry. ACTRN12608000407392.
20 weeks (individual patients were followed until death or hospital discharge).
27 level II or III ICUs in Australia and New Zealand.
1118 adults (mean age 59 y, 61% men) who were recently admitted to the ICU and expected to stay > 2 days and were not tolerating an oral diet. Palliative care, moribund, or brain-dead patients and those admitted from another ICU were excluded.
Development and implementation of a nutrition guideline (14 ICUs, 561 patients) or maintenance of usual feeding protocols (13 ICUs, 557 patients). The intensive care specialist and dietitian coinvestigators from each intervention ICU participated in a 2-day conference to develop the evidence-based feeding guideline. Physicians and staff at intervention ICUs were exposed to a multifaceted practice change strategy, including lectures, individual encouragement, active and passive reminders, and feedback.
ICU and hospital mortality and length of stay, and process measures.
100% (intention-to-treat analysis).
The guideline intervention increased the proportion of ICU patients receiving nutritional support (95% vs 73%, P < 0.001) and fed within 24 hours of admission (61% vs 37%, P < 0.001), reduced mean time to first parenteral feeding (1.0 vs 1.4 d, P = 0.04) and first enteral feeding (0.8 vs 1.4 d, P < 0.001), and increased mean proportion of days in the ICU that patients were fed (81% vs 69%, P = 0.002). Groups did not differ for mortality or length of stay (Table).
A multifaceted practice change strategy to implement an evidence-based nutritional support guideline improved feeding practices in intensive care units but did not reduce mortality.
Implementation of an evidence-based feeding guideline vs usual feeding protocols in intensive care units (ICUs)†
†CI defined in Glossary.
Ferri M, Adhikari N. Implementation of an evidence-based feeding guideline did not reduce mortality in intensive care units. Ann Intern Med. ;150:JC5–13. doi: 10.7326/0003-4819-150-10-200905190-02013
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Published: Ann Intern Med. 2009;150(10):JC5-13.
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