title: The impact of implementation of an enteral feeding protocol on the improvement of enteral nutrition in critically ill adults.
abstract: OBJECTIVE
  The optimal delivery of enteral nutrition (EN) may improve clinical outcomes in critically ill patients; thus, optimal EN protocols should be developed. The purpose of this study was to evaluate the impact of implementing an EN protocol on the improvement of EN practices and on the clinical outcomes of critically ill patients.
  
  
  METHODS
  This was a retrospective study with prospectively collected data. Multidisciplinary working group developed an evidence-based EN protocol based on an extensive review of literature and existing guidelines. Subjects included patients consecutively admitted to the ICU who received EN for more than 24 hours. EN practices and clinical outcomes were compared before and after implementation of the protocol.
  
  
  RESULTS
  A total of 270 patients were included, 134 patients before implementation and 136 after implementation of the protocol. EN was initiated earlier (35.8 vs 87.1 hours, p=0.001) and more patients received EN within 24 hours (59.6% vs 41.0%, p=0.002) after implementation of the protocol. The interval between starting EN and reaching the caloric goal was not different, but more patients reached the caloric goal after implementation (52.2% vs 38.3%, p=0.037). The post-implementation group was given more prokinetics and less parenteral nutrition. The incidences of diarrhea and gastrointestinal bleeding significantly decreased following implementation of the protocol. There was no difference in clinical outcomes including in-hospital mortality and length of hospital and ICU stay.
  
  
  CONCLUSIONS
  The implementation of the EN protocol significantly improved the practices of EN and decreased complications in critically ill patients. Clinical outcomes were not different before and after implementation.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Seoung-Hyun
authors.initials: SH
authors.lastname: Kim
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea. Email: dr99.park@samsung.com.|Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Chi-Min
authors.initials: CM
authors.lastname: Park
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Jeong-Meen
authors.initials: JM
authors.lastname: Seo
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Mingew
authors.initials: M
authors.lastname: Choi
authors.affiliation: Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Dae-Sang
authors.initials: DS
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Dong Kyung
authors.initials: DK
authors.lastname: Chang
authors.affiliation: Department of Dietetics, Samsung Medical Center, Seoul, South Korea.
authors.forename: Miyong
authors.initials: M
authors.lastname: Rha
authors.affiliation: Department of Dietetics, Samsung Medical Center, Seoul, South Korea.
authors.forename: Soyoung
authors.initials: S
authors.lastname: Yu
authors.affiliation: Department of Dietetics, Samsung Medical Center, Seoul, South Korea.
authors.forename: Seonhye
authors.initials: S
authors.lastname: Lee
authors.affiliation: Department of Dietetics, Samsung Medical Center, Seoul, South Korea.
authors.forename: Eunmee
authors.initials: E
authors.lastname: Kim
authors.affiliation: Department of Dietetics, Samsung Medical Center, Seoul, South Korea.
authors.forename: Young Yun
authors.initials: YY
authors.lastname: Cho
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002985:Clinical Protocols; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000628:therapy*; D003967:Diarrhea / Q000453:epidemiology; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D012189:Retrospective Studies; D016896:Treatment Outcome