Ella Segaran1, Ian Barker1,2, Andrew Hartle1. 1. Adult Critical Care, Imperial College Healthcare NHS Trust, London, UK. 2. Great Ormond Street Hospital, London, UK.
Abstract
BACKGROUND: Enteral nutrition is currently the route of choice for feeding critically ill patients with a functioning gut but delivery is commonly associated with disruptions. Common reasons for interruptions to enteral nutrition are fasting for diagnostic procedures, surgery and airway management. These interruptions result in significant calorie deficits that are associated with increased complications. We aimed to describe the specific interruptions in our patient group and the impact they have on nutrition delivery before and after implementation of a fasting guideline. METHODS: A service improvement project was undertaken over two different time points, 1 year apart, to evaluate the effectiveness of a fasting guideline in a general/trauma ICU in a London teaching hospital. RESULTS: There were 62 interruptions to enteral nutrition delivery with the first data collection and 64 in the second. Prolonged fasting before and after surgery and airway procedures were initially identified as the two most important causes of delays. Implementation of the fasting guideline resulted in statistical and clinical improvements in reducing fasting for airways procedures. The calorie deficit also statistically and clinically decreased as a result of the guideline. CONCLUSIONS: We conclude that the introduction of a simple guideline stipulating reduced fasting times before ICU procedures can result in less time lost in feed interruptions and improved enteral nutrition delivery.
BACKGROUND: Enteral nutrition is currently the route of choice for feeding critically illpatients with a functioning gut but delivery is commonly associated with disruptions. Common reasons for interruptions to enteral nutrition are fasting for diagnostic procedures, surgery and airway management. These interruptions result in significant calorie deficits that are associated with increased complications. We aimed to describe the specific interruptions in our patient group and the impact they have on nutrition delivery before and after implementation of a fasting guideline. METHODS: A service improvement project was undertaken over two different time points, 1 year apart, to evaluate the effectiveness of a fasting guideline in a general/trauma ICU in a London teaching hospital. RESULTS: There were 62 interruptions to enteral nutrition delivery with the first data collection and 64 in the second. Prolonged fasting before and after surgery and airway procedures were initially identified as the two most important causes of delays. Implementation of the fasting guideline resulted in statistical and clinical improvements in reducing fasting for airways procedures. The calorie deficit also statistically and clinically decreased as a result of the guideline. CONCLUSIONS: We conclude that the introduction of a simple guideline stipulating reduced fasting times before ICU procedures can result in less time lost in feed interruptions and improved enteral nutrition delivery.
Authors: Stephen A McClave; Robert G Martindale; Vincent W Vanek; Mary McCarthy; Pamela Roberts; Beth Taylor; Juan B Ochoa; Lena Napolitano; Gail Cresci Journal: JPEN J Parenter Enteral Nutr Date: 2009 May-Jun Impact factor: 4.016
Authors: Sheila E Harvey; Francesca Parrott; David A Harrison; Danielle E Bear; Ella Segaran; Richard Beale; Geoff Bellingan; Richard Leonard; Michael G Mythen; Kathryn M Rowan Journal: N Engl J Med Date: 2014-10-01 Impact factor: 91.245
Authors: Rob J M Strack van Schijndel; Peter J M Weijs; Rixt H Koopmans; Hans P Sauerwein; Albertus Beishuizen; Armand R J Girbes Journal: Crit Care Date: 2009-08-11 Impact factor: 9.097
Authors: Ella Segaran; Tracy D Lovejoy; Charlie Proctor; Wendy L Bispham; Rebecca Jordan; Bethan Jenkins; Eileen O'Neill; Sarah Ej Harkess; Marius Terblanche Journal: J Intensive Care Soc Date: 2018-01-15