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Protein Provision in Critically Ill Adults Requiring Enteral Nutrition: Are Guidelines Being Met?
Author(s) -
Mitchell Alexandra,
Clemente Rowan,
Downer Claire,
Greer Frances,
Allan Kaylee,
Collinson Avril,
Taylor Stephen
Publication year - 2019
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1002/ncp.10209
Subject(s) - medicine , medical prescription , enteral administration , parenteral nutrition , intensive care unit , critically ill , audit , emergency medicine , intensive care medicine , pediatrics , pharmacology , management , economics
Background In a previous audit, 81% of enteral protein prescriptions failed to meet protein guidelines. To address this, a very high‐protein enteral formula and protein supplements were introduced, and protein prescriptions were adjusted to account for nonnutrition energy sources displacing enteral formula. This follow‐up audit compared protein provision in critically ill adults requiring exclusive enteral nutrition (EN), first, with local and international guidelines, and second, after changes to practice, with the previous audit in the same intensive care unit (ICU). Methods Data were collected from 106 adults consecutively admitted to the ICU of a U.K. tertiary hospital and requiring exclusive EN ≥3 days. Protein targets based on local guidelines (1.25, 1.5, or 2.0 g/kg/d), nutrition prescription, and delivery were recorded for 24 hours between days 1–3, 5–7, 8–10, and 18–20 post‐ICU admission. Results The proportion of day 1–3 protein prescriptions meeting protein targets increased from 19% in 2015 to 69% in 2017 ( P < .0005, φ = 0.50). The median percentage of protein target delivered was lower than prescribed (79% vs 103%; ( P < .0005; r = 0.53) and EN delivery only met the target of 22% of patients. The proportion of protein prescriptions meeting protein targets was similar for days 1–3 (69%), 5–7 (71%), and 8–10 (68%), but increased slightly by days 18–20 (74%). The proportion of patients for which EN delivery met protein targets increased with the number of days post‐ICU admission (22%, 26%, 37%, and 53% for days 1–3, 5–7, 8–10, and 18–20, respectively). Conclusion The proportion of protein prescriptions meeting guideline targets was higher after changes to practice.