Premium
Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project
Author(s) -
Hopkins Bethany,
Cohen Sarah S.,
Irvin Sarah R.,
Alberda Cathy
Publication year - 2020
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.10364
Subject(s) - medicine , enteral administration , quality management , intensive care medicine , protein quality , quality (philosophy) , emergency medicine , parenteral nutrition , operations management , pathology , management system , philosophy , epistemology , economics
Background To meet protein needs in critical illness (CI), guidelines suggest ≥1.2–2.5 g protein/kg/d; however, most intensive care unit (ICU) patients receive ≤0.7 g/kg/d. Higher protein enteral nutrition (EN) formulas may be part of the solution to provide prescribed protein. Our objective was to demonstrate that an EN formula with 37% protein can deliver ≥80% of prescribed protein, without overfeeding calories within the first 5 days of feeding and to describe ICU clinicians' experience. Methods This quality improvement (QI) project included patients requiring exclusive EN for up to 5 days from 6 Canadian ICUs. Rationale for choosing formula, patient's BMI (kg/m 2 ), nutrition targets, daily protein and energy delivered, feeding interruptions, and general tolerance were recorded. Results Forty‐four of 49 patients received the formula ≥2 days. Average protein prescribed was 137.5 g/d (82.5–200) or 1.9 g/kg/d (1.5–2.5). Average protein delivered was 116.9 g/d (33.5–180) or 1.6 g/kg/d (0.4–2.4). Seventy‐five percent to 83% of patients received ≥80% prescribed protein on days 2–5. Average energy prescribed was 1638.6 kcal/d (990–2500) or 17.8 kcal/kg (11–26). Average energy delivered was 1523.9 kcal/d (693.0–2557.5) or 17.3 kcal/kg/d (1.35–64.7). The formula was well tolerated with no gastrointestinal symptoms reported in 38 (86%) patients. The most common reasons to prescribe the formula were obesity and use of fat‐based medications. Conclusions We demonstrated in a QI study that a high‐protein EN formula was tolerated in a small, heterogeneous group of ICU patients and effective in meeting protein targets without overfeeding.