Korean J Crit Care Med.  2010 Sep;25(3):136-143. 10.4266/kjccm.2010.25.3.136.

Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients

• Na S
• Lee H
• Koh SO
• Park AS
• Han AR

• KMID: 2228196
• DOI: http://doi.org/10.4266/kjccm.2010.25.3.136

Abstract

BACKGROUND
Nutrition delivery is frequently interrupted or delayed by physicians' ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients.
METHODS
After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for > or = 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician's recommendation within 48 hours, the patients were classified under the compliant group (Group 1).
RESULTS
Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 +/- 81 vs 157 +/- 77 mg/dl, p = 0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p = 0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2.
CONCLUSIONS
Physicians' compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.

Keyword

acute lung injury; mechanical ventilation; nutrition status; protocol compliance; tube feeding

MeSH Terms

Acute Lung Injury
Compliance
Enteral Nutrition
Guideline Adherence
Hospital Mortality
Humans
Length of Stay
Nitrogen
Nutritional Status
Nutritional Support
Oxygen
Parenteral Nutrition
Prealbumin
Respiration, Artificial
Nitrogen
Oxygen
Prealbumin