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Validation of the Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients: results of a prospective observational study.
Crit Care Med. 2004 Nov;32(11):2260-6
Publication Type
Daren K Heyland
Rupinder Dhaliwal
Andrew Day
Minto Jain
John Drover
Author Affiliation
Department of Medicine, Queen's University, Kingston, Ontario.
Crit Care Med. 2004 Nov;32(11):2260-6
Publication Type
Aged, 80 and over
Clinical Protocols - standards
Critical Care - methods - standards - statistics & numerical data
Critical Illness - therapy
Diffusion of Innovation
Enteral Nutrition - standards - statistics & numerical data
Evidence-Based Medicine - standards
Guideline Adherence - statistics & numerical data
Health Services Research
Information Dissemination
Middle Aged
Needs Assessment
Nutritional Support - methods - standards - statistics & numerical data
Patient Selection
Physician's Practice Patterns - standards - statistics & numerical data
Practice Guidelines as Topic - standards
Prospective Studies
Respiration, Artificial
Recently, evidence-based clinical practice guidelines for the provision of nutrition support in the critical care setting have been developed. To validate these guidelines, we hypothesized that intensive care units whose practice, on average, was more consistent with the guidelines would have greater success in providing enteral nutrition.
Prospective observational study.
Fifty-nine intensive care units across Canada.
Consecutive cohort of mechanically ventilated patients.
In May 2003, participating intensive care units recorded nutrition support practices on a consecutive cohort of mechanically ventilated patients who stayed for a minimum of 72 hrs. Sites enrolled an average of 10.8 (range, 4-18) patients for a total of 638. Patients were observed for an average of 10.7 days.
We examined the association between five recommendations from the clinical practice guidelines most directly related to the provision of nutrition support (use of parenteral nutrition, feeding protocol, early enteral nutrition, small bowel feedings, and motility agents) and adequacy of enteral nutrition. We defined adequacy of enteral nutrition as the percent of prescribed calories that patients actually received. Across sites, the average adequacy of enteral nutrition over the observed stay in intensive care unit ranged from 1.8% to 76.6% (average 43.0%). Intensive care units with a greater than median utilization of parenteral nutrition (>17.5% patient days) had a much lower adequacy of enteral nutrition (32.9 vs. 52.7%, p 50% of their patients within the first 48 hrs had a higher adequacy of enteral nutrition than those that did not (48.1 vs. 34.4%, p 50% utilization of motility agents and/or any small bowel feedings in patients with high gastric residuals tended to have a higher adequacy of enteral nutrition than those intensive care units that did not (45.6 vs. 39.2%, p = .04, and 48.4 vs. 41.8%, p = .16, respectively).
Intensive care units that were more consistent with the Canadian clinical practice guidelines were more likely to successfully feed patients via enteral nutrition. Adoption of the Canadian clinical practice guidelines should lead to improved nutrition support practice in intensive care units. This may translate into better outcomes for critically ill patients receiving nutrition support.
Comment In: Crit Care Med. 2004 Nov;32(11):2354-515640660
PubMed ID
15640639 View in PubMed
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