An Early Enteral Nutrition (EEN) Protocol for Adult Critically Ill Patients

Abstract

Background: Enteral nutrition (EN) is the preferred feeding route for critically ill patients who are unable to maintain volitional intake due to intubation with mechanical ventilation, as it attenuates the metabolic response to critical illness. Established guidelines support early EN (EEN) initiation within the first 24-48 hours of intubation to improve various clinical outcomes. Objectives: To determine if implementation of an EEN protocol increases the number of patients that receive EEN within 48 hours of intubation, as well as to assess the effect of EN timing on certain nutritional and clinical patient outcomes. Methods: A quasi-experimental, single-center, retrospective study involving analysis of electronic medical record (EMR) data of critically ill, intubated and mechanically ventilated, adult patients admitted to two ICUs of a community hospital was performed before (control group) and following implementation of the protocol (intervention group). The EEN protocol involved a flowchart and education sessions for staff. Demographic, clinical, and nutrition data were collected and analyzed. Results: The EEN protocol resulted in a statistically significant increase the number of patients that received early EN (p = <0.001), from 33.3% to 74.1% of patients, but this did not translate into a reduction in the primary nutrition endpoints of constipation and pressure injury progression or development, nor other clinical patient outcomes of reduced mechanical ventilation duration, mortality, or ICU and hospital length of stay (LOS). Conclusions: Implementation of an EEN protocol successfully increased the number of patients that received EEN within the recommended 48 hours of intubation, however, patient outcomes did not improve as intended. A larger study of longer duration may have been more efficacious.