title: Introduction of guidelines to facilitate enteral nutrition in a surgical intensive care unit is associated with earlier enteral feeding.
abstract: OBJECTIVE
  Patients treated postoperatively in surgical intensive care units often receive delayed enteral nutrition. We hypothesized that the introduction of guidelines promoting early enteral nutrition is associated with earlier enteral feeding.
  
  
  METHODS
  Enteral nutrition guidelines were created by the consensus of a multidisciplinary team consisting of intensivists, nurses, nutritionists, and surgeons. The guidelines were implemented through repeated staff education. We prospectively compared data on nutritional support in the surgical intensive care unit of a tertiary care center before (pre-intervention period, from January 27 to April 30, 2008) and after (post-intervention period, from May 1st to August 15th, 2008) implementation of the guidelines. The primary outcome was time to enteral feeding (oral or tube feeding).
  
  
  RESULTS
  146 patients were evaluated during the pre-period and 141 patients during the post-period. Patients during the two time periods had similar demographics and clinical characteristics. None of the patients were without nutrition for longer than 7 days. Oral or feeding tube nutrition was started earlier in the post-period (median 1 vs. 2 days, p < 0.001). There was no difference in the percentages of patients receiving parenteral nutrition (7.4 vs. 10%, p = 0.360). There was no increase in aspiration events in the post-period (8 vs. 9.4%, p = 0.606).
  
  
  CONCLUSIONS
  Introduction of guidelines to facilitate enteral nutrition in a surgical intensive care unit was associated with earlier enteral feeding.
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Boston, MA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Zacharias
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: R
authors.initials: R
authors.lastname: Blank
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Bittner
authors.affiliation: Department of Patient Care Services, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Joyce
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: D
authors.initials: D
authors.lastname: Kondili
authors.affiliation: Department of Respiratory Therapy, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: D
authors.initials: D
authors.lastname: Fisher
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA, 02114, USA.
authors.forename: M
authors.initials: M
authors.lastname: Eikermann
authors.affiliation: Division of Trauma, Emergency Surgery and Surgical Critical Care, Boston, MA, USA.
authors.forename: G C
authors.initials: GC
authors.lastname: Velmahos
authors.affiliation: Department of Anesthesia, Critical Care and Pain Medicine, 55 Fruit Street, Boston, MA, 02114, USA. uschmidt@partners.org.
authors.forename: U
authors.initials: U
authors.lastname: Schmidt
keywords: Nutrition; Surgical intensive care unit; Tube feedings
references.citation: JAMA. 1999 Oct 20;282(15):1458-65
references.pmid: 10535437
references.citation: Intensive Care Med. 2005 Jan;31(1):12-23
references.pmid: 15592814
references.citation: Crit Care. 2005 Jun;9(3):R218-25
references.pmid: 15987393
references.citation: J Am Coll Surg. 1998 Aug;187(2):142-6
references.pmid: 9704959
references.citation: Crit Care Med. 2009 May;37(5):1757-61
references.pmid: 19373044
references.citation: Am J Clin Nutr. 2001 Oct;74(4):534-42
references.pmid: 11566654
references.citation: Nutrition. 2004 Oct;20(10):843-8
references.pmid: 15474870
references.citation: JPEN J Parenter Enteral Nutr. 2009 May-Jun;33(3):277-316
references.pmid: 19398613
references.citation: Crit Care Med. 2001 Dec;29(12):2264-70
references.pmid: 11801821
references.citation: Nutr Clin Pract. 2003 Aug;18(4):279-84
references.pmid: 16215051
references.citation: Ann Surg. 1992 Aug;216(2):172-83
references.pmid: 1386982
references.citation: J Clin Nurs. 2008 Jul;17 (14 ):1851-7
references.pmid: 18578759
references.citation: J Crit Care. 2008 Jun;23(2):207-21
references.pmid: 18538214
references.citation: N Engl J Med. 2006 Dec 28;355(26):2725-32
references.pmid: 17192537
references.citation: Nutrition. 1996 Jan;12(1):23-9
references.pmid: 8838832
references.citation: J Crit Care. 2008 Sep;23(3):301-7
references.pmid: 18725033
references.citation: Crit Care Med. 2005 Jan;33(1):213-20; discussion 260-1
references.pmid: 15644672
references.citation: Crit Care Med. 2008 Nov;36(11):2993-9
references.pmid: 18824907
references.citation: J Am Coll Surg. 2008 Nov;207(5):690-7
references.pmid: 18954781
references.citation: J Trauma. 2007 Sep;63(3):630-6
references.pmid: 18073612