Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A before and after study

Background and objective Enteral nutrition (EN) feeding protocol was proposed to have positive impact on critically ill patients. However, current studies showed conflicting results. The present study aimed to investigate whether enteral feeding protocol was able to improve clinical outcomes in critically ill patients. Methods A before (stage 1) and after (stage 2) interventional study was performed in 10 tertiary care hospitals. All patients expected to stay in the intensive care unit (ICU) for over three days were potentially eligible. Clinical outcomes such as 28-day mortality, ICU length of stay, duration of mechanical ventilation (MV), and nosocomial infection were compared between the two stages. Main results A total of 410 patients were enrolled during the study period, including 236 in stage 1 and 174 in stage 2. EN feeding protocol was able to increase the proportion of EN in day 2 (41.8 +/- 22.3 vs. 50.0 +/- 28.3%; p = 0.006) and day 6 (70.3 +/- 25.2 vs. 77.6 +/- 25.8%; p = 0.006). EN percentages tended to be higher in stage 1 than that in stage 2 on other days, but statistical significance was not reached. There was no difference in 28-day mortality between stage 1 and 2 (0.14 vs. 0.14; p = 0.984). Implementation of EN feeding protocol marginally reduced ICU length of stay (19.44 +/- 18.48 vs. 16.29 +/- 16.19 days; p = 0.077). There was no difference in the duration of MV between stage a and stage 2 (14.24 +/- 14.49 vs. 14.51 +/- 17.55 days; p = 0.877). Conclusions The study found that the EN feeding protocol was able to increase the proportion of EN feeding, but failed to reduce 28-day mortality, incidence of nosocomial infection or duration of MV.