Bedside adherence to clinical practice guidelines for enteral nutrition in critically ill patients receiving mechanical ventilation: a prospective, multi-centre, observational study.
BACKGROUND
The primary aim was to measure the amount of nutrients required, prescribed and actually administered in critically ill patients. Secondary aims were to assess adherence to clinical practice guidelines, and investigate factors leading to non-adherence.


METHODS
Observational, multicenter, prospective study, including 203 patients in a total of 19 intensive care units in France. The prescribed calorie supply was compared with the theoretical minimal required calorie intake (25 Kcal/Kg/day) and with the supply actually delivered to the patient to calculate the ratio of calories prescribed/required and the ratio of calories delivered/prescribed. Clinical factors suspected to influence enteral nutrition were analyzed by univariate and multivariate analysis.


RESULTS
The median ratio of prescribed/required calories per day was 43 [37-54] at day 1 and increased until day 7. From day 4 until the end of the study, the median ratio was > 80%. The median ratio of delivered/prescribed per day was > 80% for all 7 days from the start of enteral nutrition. Among the variables tested (hospital type, use of a local nutrition protocol, sedation, vasoactive drugs, number of interruptions of enteral nutrition and measurement of gastric residual volume), only measurement of residual volume was significant by univariate analysis. This was confirmed by multivariate analysis, where gastric residual volume measurement was the only variable independently associated with the ratio of delivered/prescribed calories (OR = 1.38; 95%CI, 1.12-2.10, p = .024).


CONCLUSIONS
The translation of clinical research and recommendations for enteral nutrition into routine bedside practice in critically ill patients receiving mechanical ventilation was satisfactory, but could probably be improved with a multidisciplinary approach.
Service de Réanimation Médicale, Bocage University Hospital, Boulevard de Lattre de Tassigny, Dijon, France. jean-pierre.quenot@chu-dijon.fr
Jean-Pierre
JP
Quenot
Gaetan
G
Plantefeve
Jean-Luc
JL
Baudel
Isabelle
I
Camilatto
Emmanuelle
E
Bertholet
Romain
R
Cailliod
Jean
J
Reignier
Jean-Philippe
JP
Rigaud
D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D016638:Critical Illness; D004750:Enteral Nutrition / Q000592:standards*; D005260:Female; D005602:France; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D012121:Respiration, Artificial