Implementation of a perioperative enteral nutrition guideline in the intensive care unit

Author(s):
Talya Lorenz; Julia Cartwright; Anna Krzak; Jill Cherry-Bukowiec; Mike Korona

Background:

The goal of adequate nutrition is to minimize the loss of lean body mass associated with the catabolic stress response seen in critical illness. Enteral nutrition (EN) supplementation has been shown to reduce complications, shorten length of stay, and improve patient outcomes. Critically ill adults are at increased nutritional risk secondary to delays in EN initiation and frequent cessation of EN for procedures. The use of evidence-based nurse-driven fasting guidelines may help mitigate the cumulative nutrition deficits caused by unnecessary EN interruptions.

Hypothesis:

Implementation of a peri-procedural EN guideline in critically ill patients undergoing operative interventions will reduce negative caloric balance accumulation without increased incidence of aspiration pneumonia

Methods:

Preliminary data involved a retrospective chart review performed in 2013 and 2015 for adult, burn patients undergoing operative intervention at an academic hospital and verified burn center. This review demonstrated zero aspiration events or post-operative aspiration pneumonia in 27 patients (69 operative cases, TBSA rang 3-80%) who received post-pyloric, perioperative EN. Prospective data was then collected from 2016-2018 in patients meeting the same inclusion criteria. Data was collected regarding the nature of surgical procedure, airway assessment, location of feeding tube, perioperative EN infusion, events of intra-operative witnessed aspiration and post-operative aspiration pneumonia.

Results:

There were zero aspiration events and no evidence of post-operative aspiration pneumonia in burn patients who received peri-procedural feedings from 2016-2018. Given the demonstrated safety, a draft protocol was designed to include critically ill surgical patients in need of procedural interventions. This draft protocol was created and implemented in the surgical ICUs with multidisciplinary input.

Conclusions:

Perioperative feeding is safe for burn patients with secure airways receiving post-pyloric EN during supine, operative procedures. Implementation of a perioperative feeding protocol for eligible, critically ill patients at nutrition risk should be further studied for safety and nutrition-related patient outcomes.