title: The application of a feeding protocol in older patients fed through percutaneous endoscopic gastrostomy tubes by the intermittent or bolus methods: a single-center, retrospective chart review.
abstract: BACKGROUND
  While previous studies have reported that feeding protocols improved clinical outcomes in critical care settings, the evidence supporting the application of feeding protocols in older patients has not yet been assessed. Here, we evaluated the effects of a feeding protocol in older patients fed through percutaneous endoscopic gastrostomy (PEG) tubes.
  
  
  METHODS
  We conducted a retrospective chart review of 109 patients aged >=65 who underwent PEG placement between April 2010 and March 2012 at a single acute care hospital. The protocol group was administered enteral nutrition (EN) according to a feeding protocol, while the non-protocol group was administered EN at the attending physician's discretion.
  
  
  RESULTS
  Length of hospital stay (LOS) overall and after EN initiation were significantly shorter in the protocol group than in the non-protocol group. (LOS: p=0.001; LOS after EN initiation: p=0.026). During the second week after EN initiation, significantly fewer patients had percutaneous oxygen saturation (SpO2) <93% and required oxygen therapy in the protocol group (p=0.032 for both comparisons). Nutrition intakes via PEG in the protocol group were significantly greater from Days 6 to 13 for energy and from Days 6 to 11 for protein compared with the non-protocol group.
  
  
  CONCLUSIONS
  The application of a feeding protocol after PEG placement in older patients was associated with shorter LOS, more efficient EN delivery, and lower incidence of low SpO2 than non-protocol group. Larger prospective studies are required to determine whether a feeding protocol is useful in improving health outcomes in this population.
authors: Department of Nutrition Management, Kobe City Medical Center General Hospital, Hyogo, Japan. satomi.ichimaru@gmail.com
authors: Satomi
authors: S
authors: Ichimaru
authors: Teruyoshi
authors: T
authors: Amagai
authors: Yoshihiko
authors: Y
authors: Shiro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007441:Intubation, Gastrointestinal / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009752:Nutritional Status; D012189:Retrospective Studies