Research
Bedside adherence to clinical practice guidelines for enteral nutrition in critically ill patients receiving mechanical ventilation: a prospective, multi-centre, observational study
1 Service de Réanimation Médicale, Bocage University Hospital, Boulevard de Lattre de Tassigny, 21079 Dijon, France
2 Service de réanimation polyvalente, CH Victor Dupouy d'Argenteuil, 69 rue du Lieutenant Colonel Prudhon, 95107 Argenteuil, France
3 Service de Réanimation Médicale, CHU de Saint-Antoine, 184 rue du faubourg Saint-Antoine, 75012 Paris, France
4 Service de Réanimation Médicale, Hôpital Emile Muller, 20 Avenue du Docteur René Laennec, 68100 Mulhouse, France
5 Service de Néonatologie, CHU de Lyon, 59 Boulevard Pinel, 69500 Bron, France
6 Service de Biostatistiques et Informatique Médicale, Département d'Information Médicale, Bocage University Hospital, Boulevard de Lattre de Tassigny, 21079 Dijon, France
7 Service de Réanimation polyvalente, CHD les Oudairies, 89925 La Roche sur Yon Cedex 09, France
8 Service de Réanimation polyvalente, CH de Dieppe, Avenue Pasteur, 76202 Dieppe, France
Critical Care 2010, 14:R37 doi:10.1186/cc8915
Published: 16 March 2010Abstract
Introduction
The primary aim was to measure the amount of nutrients required, prescribed and actually administered in critically ill patients. Secondary aims were to assess adherence to clinical practice guidelines, and investigate factors leading to non-adherence.
Methods
Observational, multicenter, prospective study, including 203 patients in a total of 19 intensive care units in France. The prescribed calorie supply was compared with the theoretical minimal required calorie intake (25 Kcal/Kg/day) and with the supply actually delivered to the patient to calculate the ratio of calories prescribed/required and the ratio of calories delivered/prescribed. Clinical factors suspected to influence enteral nutrition were analyzed by univariate and multivariate analysis.
Results
The median ratio of prescribed/required calories per day was 43 [37-54] at day 1 and increased until day 7. From day 4 until the end of the study, the median ratio was > 80%. The median ratio of delivered/prescribed per day was > 80% for all 7 days from the start of enteral nutrition. Among the variables tested (hospital type, use of a local nutrition protocol, sedation, vasoactive drugs, number of interruptions of enteral nutrition and measurement of gastric residual volume), only measurement of residual volume was significant by univariate analysis. This was confirmed by multivariate analysis, where gastric residual volume measurement was the only variable independently associated with the ratio of delivered/prescribed calories (OR = 1.38; 95%CI, 1.12-2.10, p = .024).
Conclusions
The translation of clinical research and recommendations for enteral nutrition into routine bedside practice in critically ill patients receiving mechanical ventilation was satisfactory, but could probably be improved with a multidisciplinary approach.
