title: Volume-Based Enteral Nutrition Support Regimen Improves Caloric Delivery but May Not Affect Clinical Outcomes in Critically Ill Patients.
abstract: Meeting enteral nutrition goals is an ongoing challenge in the intensive care unit (ICU). Most hospitals use rate-based (RB) protocols for nutrient delivery. Previous studies have found that volume-based (VB) protocols improve delivery of prescribed calories. However, these studies did not assess clinical outcomes. We hypothesize that a VB method will improve the delivery of prescribed calories and lead to improved clinical outcomes.
  
  
  
  A before-and-after study was performed following implementation of a VB feeding protocol in an adult mixed medical-surgical ICU. Formal institutional review board approval was obtained. The effect of RB and VB protocols on percentage of goal calories received, ICU length of stay (LOS), hospital LOS, mortality, days on the ventilator, and rates of infection were investigated using the Kruskal-Wallis test of differences. Multivariate regression was used to identify independent predictors of outcome. Significance was defined as P < .05.
  
  
  
  A total of 77 patients were included (RB = 39, VB = 38). There were no differences in demographics between the 2 groups with the exception of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score, which was significantly higher in the VB group. VB patients received significantly more prescribed calories (74% vs 57%, P < .001). VB patients had significantly longer ICU LOS and duration of mechanical ventilation on univariate analysis. These differences did not persist after controlling for APACHE II score.
  
  
  
  VB enteral feeding allows for a significantly greater provision of prescribed calories but may not affect clinical outcomes. A larger sample size is needed for adequate power to corroborate these findings.
authors.affiliation: 1 Center for Trauma and Critical Care, The George Washington University Hospital, Washington, DC.
authors.forename: Ivy N
authors.initials: IN
authors.lastname: Haskins
authors.affiliation: 2 Department of Clinical Nutrition, The George Washington University Hospital, Washington, DC.
authors.forename: Mary
authors.initials: M
authors.lastname: Baginsky
authors.affiliation: 1 Center for Trauma and Critical Care, The George Washington University Hospital, Washington, DC.
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Gamsky
authors.affiliation: 1 Center for Trauma and Critical Care, The George Washington University Hospital, Washington, DC.
authors.forename: Kia
authors.initials: K
authors.lastname: Sedghi
authors.affiliation: 1 Center for Trauma and Critical Care, The George Washington University Hospital, Washington, DC.
authors.forename: Sojung
authors.initials: S
authors.lastname: Yi
authors.affiliation: 1 Center for Trauma and Critical Care, The George Washington University Hospital, Washington, DC.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Amdur
authors.affiliation: 2 Department of Clinical Nutrition, The George Washington University Hospital, Washington, DC.
authors.forename: Mary
authors.initials: M
authors.lastname: Gergely
authors.affiliation: 1 Center for Trauma and Critical Care, The George Washington University Hospital, Washington, DC.
authors.forename: Babak
authors.initials: B
authors.lastname: Sarani
mesh_terms: D018806:APACHE; D000368:Aged; D015992:Body Mass Index; D002985:Clinical Protocols; D016638:Critical Illness / Q000401:mortality* / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D016896:Treatment Outcome
keywords: critically ill; enteral nutrition; parenteral nutrition; underfeeding