Optimizing Enteral Nutrition in Critically Ill, Mechanically Ventilated Adult Patients

Abstract

Research has indicated that many instances of iatrogenic malnutrition among critically ill adults was connected to inadequate feeding practices within the critical care units. The purpose of this quantitative, quasi-experimental project was to determine if or to what degree the implementation of an evidence-based enteral nutrition protocol would impact enteral caloric intake and increase serum albumin levels for critically ill, mechanically ventilated patients in a mixed medical-surgical intensive care unit at a community hospital in the metropolitan Phoenix area over four weeks. The quality improvement project was based on the theoretical frameworks of Maslow and Neuman, in addition to, the Nutritional Care Process Model to govern the assessment and implementation process for an enteral feeding program. A total of seven patients were identified who met criteria for the pre-intervention group and a total of five patients were identified who met criteria for inclusion in the post-intervention group. A Mann-Whitney U statistical analysis was used to show the differences between the pre-intervention group and the post-intervention groups. The post-intervention group showed an increase in cumulative caloric intake as compared to the pre-intervention group (U=2.00; p=0.01). However, there was no statistically significant difference between the changes in albumin for the pre-intervention group and the post-intervention group (U=7.50; p=0.177) Therefore, the findings suggested that the implementation of an enteral nutrition protocol to guide clinical practice may improve enteral caloric intake for mechanically ventilated, critically ill patients. Recommendations included extending the project in other units who have mechanically ventilated patient over a longer period with an aim of attaining a larger sample size in order to analyze serum albumin levels.