This issue of Journal of Neuroscience Nursing contains a study that examined implementation of an enteral nutrition (EN) protocol within three intensive care units (ICUs) in a regional suburban medical center. In this section of "research bytes," we break down specific aspects of the study to highlight what was done and how findings inform clinical practice.

Study Purpose

The primary aim was to examine the effects of an EN protocol on time to initiation of feedings and adherence to prescribed feeding goals.

Significance

Adequate nutrition positively impacts patient outcomes. However, critically ill patients often do not receive required amounts to optimize healing and recovery. Inadequate nutrition results in increased infections, poor wound healing, and muscle weakness, negatively impacting ventilator days, length of stay, and mortality. Integration of an evidence-based EN protocol is one approach to ensure nutritional needs among critically ill patients are addressed early and consistently, but research is needed to gauge effectiveness.

Methods

A pre/post design was used to compare outcomes among critically ill patients before and after integration of the EN protocol. The sample included 51 critically ill patients from three ICUs (medical surgical ICU, cardiac ICU, and neurological ICU). A multidisciplinary committee created and implemented the EN protocol (see Table 1 in the article). Data were gathered on 33 critically ill, mechanically ventilated adults before initiation of the protocol. The same data points were then gathered on 18 patients after protocol implementation. Variables included time of intubation, time EN was ordered and initiated, prescribed EN goal, amount of EN received, and amount of time EN was infused. Outcome variables were percentage of time EN was started within 48 hours and percentage of time patients who received 60% of EN goals.

Results

After initiation of the EN protocol, the percentage of patients who had EN initiation within 48 hours increased from 54.5% to 83.3%. Similarly, a higher percentage of patients received 60% of goal EN after introduction of the protocol (63.6% and 77.8%, respectively). Analyses were not performed to determine if differences in pre and post groups were statistically significant, and it is not clear if the resulting sample size contained adequate power to definitively support study findings. Descriptive characteristics of the study population are not provided, so it is difficult to ascertain if the preintervention and postintervention groups were similar in terms of age, diagnoses, and underlying comorbidities, which could impact EN therapy. Nevertheless, it does appear that introduction of an EN protocol may positively impact short-term nutritional outcomes.

Clinical Implications

This project highlights specific components of an evidence-based EN protocol that can be integrated into routine care for critically ill patients receiving mechanical ventilation. Use of the protocol may aid in standardizing EN evaluations and interventions in the ICU. The improved percentages in time to EN initiation and attainment of nutritional goals suggest potential positive effects. Additional research is needed to substantiate findings among matched cohorts, using inferential statistics, before definitive practice recommendations can be made.