Imperial Valley Evidence-Based Practice Conference Enteral Nurtrition in the ICU

1. Practice Problem • Underfeeding is known to be a problem with patients on mechanical ventilators. • Critically ill patients suffer adverse effects due to malnutrition. • Often times critically ill patients are prescribed the appropriate caloric intake, however do not always receive the full amount prescribed. • It is uncertain as to which particular step during administration of enteral nutrition prevents administration of the prescribed dose. Literature Review Imperial Valley Evidence-Based Practice ConferenceEnteral Nurtrition in the ICU • Enteral Nutrition Interruptions: • Problems with SBFT • Residual volumes • Weaning • Procedures • Radiology • Surgery preparation • Shock • Bath • Emesis • Skin care • Key Findings • Feedings need to start within 24-48 hours upon ICU admit. • Only 50% of the nutritional requirements were delivered. • Feedings were interrupted on average 6 hours per day per patient (25% of daily feeding). • No consensus exists on what constitutes feeding tolerance (residual, rate of infusion). PICO In critically ill patients requiring mechanical ventilation, does addition of standardized enteral feeding orders to the current initial ventilator protocol, support patients in receiving their daily prescribed caloric intake? • Improvement • Add standardized enteral feeding orders to current ventilator pre-printed protocols to initiate feedings within 24-48 hours and limit interruptions. • Daily collaboration with RN, dietician, and physician to ensure nutritional continuity. Literature Cited Barr, et.al. (2004). Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest. 125(4). O’Meara, et.al (2008). Evaluation of delivery of enteralnurtrition in critically ill patients receiving mechanical ventilation. American Journal of Critical Care, 17;1 Presented by SDSU: Mykell Johnston RN, BSc Juanita Martinez RN, BSc