Volume-based enteral feeding for ward patients with acute neurological conditions: a pilot prospective cohort study

IF 2.9 3区医学 Q3 NUTRITION & DIETETICS Journal of Human Nutrition and Dietetics Pub Date : 2024-05-16 DOI:10.1111/jhn.13319

Jessie A. Varghese, Simone Keegan, Christine Nicholson, Katharine J. Drummond, Neha Kaul, Kate Fetterplace

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Abstract

Background

Patients requiring enteral nutrition (EN) after neurological insults experience feeding interruptions, contributing to inadequate nutrition delivery. This prospective cohort study investigated if volume-based enteral feeding (VBF) improved the delivery of prescribed EN volume in ward patients with acute neurological conditions.

Methods

Over two sequential periods, the usual care group received standard continuous rate-based feeding, and the intervention group received VBF with bi-daily EN rate adjustments to achieve target daily volume. The primary outcome was percentage of prescribed daily EN formula volume delivered. Differences in energy and protein provision, weight, malnutrition and safety were explored. An evaluation survey captured nurse acceptability of the protocol.

Results

The intervention group (n = 32) achieved greater median interquartile range (IQR) EN adequacy of prescribed volume at 92% (88–97) compared to 67% (54–78) for usual care (n = 35) (p < 0.001). VBF compared to rate-based feeding resulted in patients receiving more kilojoules (131 [121–138] kJ/kg vs. 84 [64–99] kJ/kg; p < 0.001) and protein (1.3 [1.2–1.5] g/kg vs. 0.9 [0.6–1.1] g/kg; p < 0.001). There were no differences in gastrointestinal intolerance between groups. Compliance to the VBF protocol was 90%, and 78% of staff reported high confidence using the protocol. The intervention group had less median weight loss at discharge (−1.4 [0.1 to −4.3] kg) than usual care (−3.6 [−1.3 to 8.4] kg; p < 0.011), but no differences in malnutrition status were observed.

Conclusion

A VBF protocol delivered greater EN volume, energy and protein following neurological injury. The VBF protocol was feasible with high acceptability from nursing staff.

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急性神经系统疾病病房患者的容量式肠内喂食：一项前瞻性队列试点研究。

背景：神经损伤后需要肠内营养（EN）的患者会出现喂食中断，导致营养供给不足。这项前瞻性队列研究调查了以容量为基础的肠内喂养（VBF）是否能改善急性神经系统疾病病房患者的肠内营养供给量：在两个连续的时间段内，常规护理组接受标准的连续速率喂养，干预组接受基于容量的肠内喂养，每天调整两次EN速率以达到目标日喂养量。主要结果是每日EN配方喂养量占规定喂养量的百分比。研究还探讨了能量和蛋白质供应、体重、营养不良和安全性方面的差异。一项评估调查反映了护士对方案的接受程度：结果：干预组（n = 32）的中位数四分位数间距（IQR）EN充足率达到92%（88-97），而常规护理组（n = 35）的中位数四分位数间距（IQR）EN充足率仅为67%（54-78）（p 结论：VBF方案能提供更多的EN：VBF 方案可在神经损伤后提供更多的EN容量、能量和蛋白质。VBF 方案可行，护理人员接受度高。

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来源期刊

Journal of Human Nutrition and Dietetics 医学-营养学

CiteScore

5.30

自引率

15.20%

发文量

133

审稿时长

6-12 weeks

期刊介绍： Journal of Human Nutrition and Dietetics is an international peer-reviewed journal publishing papers in applied nutrition and dietetics. Papers are therefore welcomed on: - Clinical nutrition and the practice of therapeutic dietetics - Clinical and professional guidelines - Public health nutrition and nutritional epidemiology - Dietary surveys and dietary assessment methodology - Health promotion and intervention studies and their effectiveness - Obesity, weight control and body composition - Research on psychological determinants of healthy and unhealthy eating behaviour. Focus can for example be on attitudes, brain correlates of food reward processing, social influences, impulsivity, cognitive control, cognitive processes, dieting, psychological treatments. - Appetite, Food intake and nutritional status - Nutrigenomics and molecular nutrition - The journal does not publish animal research The journal is published in an online-only format. No printed issue of this title will be produced but authors will still be able to order offprints of their own articles.