Improving Enteral Delivery Through the Adoption of the “Feed Early Enteral Diet Adequately for Maximum Effect (FEED ME)” Protocol in a Surgical Trauma ICU

Abstract

Background: Despite the research supporting adequate enteral nutrition (EN) in intensive care unit (ICU) patients, underfeeding is still common. This quality improvement (QI) project was done to determine the effect of “volume-based” feeding on adequacy of EN delivery and provision of calories and protein in a surgical/trauma ICU (STICU). Materials and Methods: Mechanically ventilated STICU patients (n = 111) fed at least 72 hours after achieving their target goal of EN during their first week of admission were reviewed retrospectively in a QI project. Data were obtained before (n = 54) and after (n = 56) initiation of a “volume-based” feeding protocol (FEED ME—Feed Early Enteral Diet adequately for Maximum Effect). Results: The proportion of EN volume and calories delivered increased significantly (rate based, 63% ± 20%; FEED ME, 89% ± 9%; P < .0001), as did grams of protein/kg actual body weight (1.13 ± .29 to 1.26 ± .37; P = .036) using the FEED ME protocol. Groups were similar in patient demographics, clinical characteristics, and nutrition practices. Only slightly more diarrhea (rate based, 0; FEED ME, 6; P = .046) in gastric-fed patients was noted. The incidence of gastric residual volume >350 mL (rate-based, 20 episodes; FEED ME, 11 episodes; P = .34) and emesis (5 vs 2 episodes; P = .22) was similar. Conclusion: A change in standard of practice to an EN volume-based feeding approach in a STICU led to a significant improvement in adequacy of calories and protein delivered, with only a slight increase in diarrhea.