title: Volume-Based Feeding in the Critically Ill Patient.
abstract: BACKGROUND
  Critically ill patients placed on enteral nutrition (EN) are usually underfed. A volume-based feeding (VBF) protocol designed to adjust the infusion rate to make up for interruptions in delivery should provide a greater volume of EN than the more common fixed hourly rate-based feeding (RBF) method.
  
  
  METHODS
  This single-center, randomized (3:1; VBF/RBF) prospective study evaluated critically ill patients on mechanical ventilation expected to receive EN for ≥ 3 days. Once goal rate was achieved, the randomized feeding strategy was implemented. In the VBF group, physicians used a total goal volume of feeds to determine an hourly rate. For the RBF group, physicians determined a constant hourly rate of infusion to meet goal feeds.
  
  
  RESULTS
  Sixty-three patients were enrolled in the study with a mean age of 52.6 years (60% male). Six patients were excluded after randomization because of early extubation. The VBF group (n = 37) received 92.9% of goal caloric requirements with a mean caloric deficit of -776.0 kcal compared with the RBF group (n = 20), which received 80.9% of goal calories (P = .01) and a caloric deficit of -1933.8 kcal (P = .01). Uninterrupted EN was delivered for 51.7% of all EN days in VFB patients compared with 54.5% in RBF patients. On days when feeding was interrupted, VFB patients overall received a mean 77.6% of goal calories (while RBF patients received 61.5% of goal calories, P = .001). No vomiting, regurgitation, or feeding intolerance occurred due to VBF.
  
  
  CONCLUSIONS
  A VBF strategy is safe and improves delivery to better meet caloric requirements than the standard more commonly used rate-based strategy.
authors.affiliation: Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky samcclave@louisville.edu.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
authors.affiliation: Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Saad
authors.affiliation: Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Mark
authors.initials: M
authors.lastname: Esterle
authors.affiliation: Department of Dietetics, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Mary
authors.initials: M
authors.lastname: Anderson
authors.affiliation: Department of Dietetics, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Alice E
authors.initials: AE
authors.lastname: Jotautas
authors.affiliation: Department of Surgery, University of Louisville School of Medicine, Louisville, Kentucky.
authors.forename: Glen A
authors.initials: GA
authors.lastname: Franklin
authors.affiliation: Department of Medicine, Queens University, Kingston, Ontario.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Hurt
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D011446:Prospective Studies; D012121:Respiration, Artificial; D055815:Young Adult
keywords: enteral nutrition; rate-based feeding; volume-based feeding