Abstract
Background
Unintentional underfeeding is common in patients receiving enteral nutrition (EN),
and is associated with increased risk of malnutrition complications. Protocols for
EN in critically ill patients have been shown to enhance adequacy, resulting in better
clinical outcomes; however, outside of intensive care unit (ICU) settings, the influence
of a protocol for EN is unknown.
Objective
To evaluate the efficacy and safety of implementing an EN protocol in a noncritical
setting.
Design
Randomized controlled clinical trial.
Participants and settings
This trial was conducted from 2014 to 2016 in 90 adult hospitalized patients (non-ICU)
receiving exclusively EN. Patients with carcinomatosis, ICU admission, or <72 hours
of EN were excluded.
Intervention
The intervention group received EN according to a protocol, whereas the control group
was fed according to standard practice.
Main outcome measures
The proportion of patients receiving ≥80% of their caloric target at Day 4 after EN
initiation.
Statistical analyses performed
Student t test or Wilcoxon rank-sum test were used for continuous variables and the difference
between the groups in the time to receipt of the optimal amount of nutrition was analyzed
using Kaplan-Meier curves.
Results
Forty-five patients were randomized to each group. At Day 4 after EN initiation, 61%
of patients in the intervention arm had achieved the primary end point compared with
23% in the control group (P=0.001). In malnourished patients, 63% achieved the primary end point in the intervention
group compared with 16% in the control group (P=0.003). The cumulative deficit on Day 4 was lower in the intervention arm compared
with the control arm: 2,507 kcal (interquartile range [IQR]=1,262 to 2,908 kcal) vs
3,844 kcal (IQR=2,620 to 4,808 kcal) (P<0.001) and 116 g (IQR=69 to 151 g) vs 191 g (IQR=147 to 244 g) protein (P<0.001), respectively. The rates of gastrointestinal complications were not significantly
different between groups.
Conclusions
Implementation of an EN protocol outside the ICU significantly improved the delivery
of calories and protein when compared with current standard practice without increasing
gastrointestinal complications.
Keywords
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Biography
L. A. Ortíz-Reyes is a master's student, Escuela Superior de Medicina, Posgrado, Instituto Politécnico Nacional and Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Biography
L. Castillo-Martínez is a medical researcher, Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Biography
A. I. Lupián-Angulo is a social service intern, Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Biography
A. E. Serralde-Zúñiga is a medical researcher, Clinical Nutrition Service, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.
Biography
D. D. Yeh is an associate professor of surgery, Ryder Trauma Center, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL.
Biography
H. I. Rocha-González is a researcher, Escuela Superior de Medicina, Posgrado, Instituto Politécnico Nacional, Mexico City, Mexico.
Article info
Publication history
Published online: December 20, 2017
Accepted:
September 22,
2017
Received:
March 1,
2017
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT The National Council of Science and Technology (CONACYT) provided a graduate scholarship for the principal investigator. The CONACYT took no part in design, conduct of the study, collection, management, analysis, interpretation of the data, preparation, review, and approval of the manuscript.
ClinicalTrials.gov identifier: NCT02740205.
Identification
Copyright
© 2018 by the Academy of Nutrition and Dietetics.
