title: Impact of enteral feeding protocols on enteral nutrition delivery: results of a multicenter observational study.
abstract: BACKGROUND
  To evaluate the effect of enteral feeding protocols on key indicators of enteral nutrition in the critical care setting.
  
  
  METHODS
  International, prospective, observational, cohort studies conducted in 2007 and 2008 in 269 intensive care units (ICUs) in 28 countries were combined for the purposes of this analysis. The study included 5497 consecutively enrolled, mechanically ventilated, adult patients who stayed in the ICU for at least 3 days. Sites recorded the presence or absence of a feeding protocol operational in their ICU. They provided selected nutritional data on enrolled patients from ICU admission to ICU discharge for a maximum of 12 days. Sites that used a feeding protocol were compared with those that did not.
  
  
  RESULTS
  On average, protocolized sites used more enteral nutrition (EN) alone (70.4% of patients vs 63.6%, P = .0036), started EN earlier (41.2 hours from admission to ICU vs 57.1, P = .0003), and used more motility agents in patients with high gastric residual volumes (64.3% of patients vs 49.0%, P = .0028) compared with sites that did not use a feeding protocol. Overall nutritional adequacy (61.2% of patients' caloric requirements vs 51.7%, P = .0003) and adequacy from EN were higher in protocolized sites compared with nonprotocolized sites (45.4% of requirements vs 34.7%, P < .0001). EN adequacy remained significantly higher after adjustment for pertinent patient and ICU level baseline characteristics.
  
  
  CONCLUSIONS
  The presence of an enteral feeding protocol is associated with significant improvements in nutrition practice compared with sites that do not use such a protocol.
authors.affiliation: Department of Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.forename: Naomi E
authors.initials: NE
authors.lastname: Cahill
authors.forename: Rupinder
authors.initials: R
authors.lastname: Dhaliwal
authors.forename: Xiaoqun
authors.initials: X
authors.lastname: Sun
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Day
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D003695:Delivery of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D004750:Enteral Nutrition / Q000592:standards* / Q000706:statistics & numerical data; D005769:Gastrointestinal Motility; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D044342:Malnutrition / Q000453:epidemiology / Q000517:prevention & control*; D009751:Nutritional Requirements; D019370:Observation; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011446:Prospective Studies; D012121:Respiration, Artificial