Abstract

Background

Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes.

Methods

We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment.

Results

Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference − 0.40 [95% CI − 0.71 to − 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference − 1.6% [95% CI − 4.3% to 1.2%]; P = 0.42) between groups.

Conclusions

In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness.

Trial registration: ISRCTN, ISRCTN12233792. Registered November 20th, 2017.

Details

Title
Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial
Author
Lu, Ke; Lin, Jiajia; Doig, Gordon S; Arthur R. H. van Zanten; Wang, Yang; Xing, Juan; Zhang, Zhongheng; Chen, Tao; Zhou, Lixin; Jiang, Dongpo; Shi, Qindong; Lin, Jiandong; Liu, Jun; Cheng, Aibin; Liang, Yafeng; Gao, Peiyang; Sun, Junli; Liu, Wenming; Yang, Zhenyu; Zhang, Rumin; Xing, Wei; Zhang, An; Zhou, Zhigang; Zhou, Tingfa; Liu, Yang; Tong, Fei; Wang, Qiuhui; Pan, Aijun; Huang, Xiaobo; Fan, Chuming; Lu, Weihua; Shi, Dongwu; Wang, Lei; Li, Wei; Gu, Liming; Xie, Yingguang; Sun, Rongqing; Guo, Feng; Lin, Han; Zhou, Lihua; Zheng, Xiangde; Feng, Shan; Liu, Jianbo; Ai, Yuhang; Qu, Yan; Li, Liandi; Li, Hailing; Pan, Zhiguo; Xu, Donglin; Zou, Zhiqiang; Gao, Yan; Yang, Chunli; Kou, Qiuye; Zhang, Xijing; Wu, Jinglan; Qian, Chuanyun; Zhang, Weixing; Zhang, Minjie; Zong, Yuan; Qin, Bingyu; Zhang, Fusen; Zhai, Zhe; Sun, Yun; Chang, Ping; Yu, Bo; Yu, Min; Yuan, Shiying; Deng, Yijun; Zhao, Liyun; Zang, Bin; Li, Yuanfei; Zhou, Fachun; Chen, Xiaomei; Shao, Min; Wu, Weidong; Wu, Ming; Zhang, Zhaohui; Li, Yimin; Guo, Qiang; Wang, Zhiyong; Gong, Yuanqi; Song, Yunlin; Qian, Kejian; Feng, Yongjian; Fu, Baocai; Liu, Xueyan; Li, Zhiping; Gong, Chuanyong; Sun, Cheng; Yu, Jian; Tang, Zhongzhi; Huang, Linxi; Ma, Biao; He, Zhijie; Zhou, Qingshan; Yu, Rongguo; Tong, Zhihui; Li, Weiqin  VIAFID ORCID Logo  ; for the Chinese Critcal Care Nutrition Trials Group (CCCNTG)
Pages
1-12
Section
Research
Publication year
2022
Publication date
2022
Publisher
BioMed Central
ISSN
13648535
e-ISSN
1366609X
Source type
Scholarly Journal
Language of publication
English
DOI
https://doi.org/10.1186/s13054-022-03921-5
ProQuest document ID
2630445492
Copyright
© 2022. This work is licensed under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.