title: A Canadian survey of perceived barriers to initiation and continuation of enteral feeding in PICUs.
abstract: OBJECTIVE
  Clinicians believe nutrition support is important; however, delivery of enteral nutrition may be delayed or interrupted due to a lack of guidelines or perceived contraindications to administration. The aim of this national survey was to examine the knowledge and perceived barriers among clinicians which prevent enteral nutrition administration to PICU patients.
  
  
  METHODS
  The survey consisted of 23 questions (19 primary and four branching). The survey was validated using a semistructured pilot test by three pediatric critical care intensivists and two pediatric critical care registered dietitians external to the study team.
  
  
  METHODS
  The survey was electronically distributed to clinicians in all PICUs across Canada.
  
  
  METHODS
  One hundred sixty-two PICU clinicians, including 96 staff intensivists, eight clinical assistants, 36 fellows, and 22 registered dietitians from PICUs across Canada.
  
  
  METHODS
  None.
  
  
  RESULTS
  The survey was administered from January to March 2013. The response rate was 50% (55 staff intensivists, two clinical assistants, nine fellows, and 15 registered dietitians). There was high variability among clinicians regarding reasons to delay the onset of enteral nutrition or interrupt enteral nutrition administration. High variability (> 70% agreement and < 10% disagreement or vice versa) was found for some reasons to delay or interrupt enteral nutrition, including lactates (rising or > 2 or > 4 mmol/L), high gastric residual volumes, CT/MRI scans, and hypoplastic left heart syndrome. Sixty-eight percent of PICU clinicians reported no written feeding protocol to be in place.
  
  
  CONCLUSIONS
  Overall, there is high variability among clinicians regarding acceptable procedural and clinical barriers to enteral nutrition administration; this may be improved by a standardized feeding protocol. Therefore, further research must be conducted to provide clinicians with evidence to support their practices for enteral nutrition administration.
authors.affiliation: 1Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, AB, Canada. 2Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada. 3Nutrition Services Alberta Health Services, Stollery Children's Hospital, Edmonton, AB, Canada.
authors.forename: Amanda Y
authors.initials: AY
authors.lastname: Leong
authors.forename: Kristina R
authors.initials: KR
authors.lastname: Cartwright
authors.forename: Gonzalo Garcia
authors.initials: GG
authors.lastname: Guerra
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.forename: Vera C
authors.initials: VC
authors.lastname: Mazurak
authors.forename: Bodil M K
authors.initials: BM
authors.lastname: Larsen
mesh_terms: D002170:Canada; D002648:Child; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008297:Male; D011795:Surveys and Questionnaires