Early Enteral Nutrition Met Calories Goals Led by Nurse on Improve Clinical Outcome: A Systematic Scoping Review

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Abstract

Background:

Critically ill patients face challenges in hypercatabolism due to crisis states, as it may lead to malnutrition. An early Enteral Nutrition (EN) within 24–48 h is recommended to use in order to improve clinical outcomes. This systematic scoping review is examined recently with the evidence of the early EN protocol led by nurses to drive and achieve the daily calorie target and improve clinical outcomes.

Materials and Methods:

The database of CINAHL, MEDLINE via PubMed and Scopus, Web of Science, and Embase through Ovid from January 2019 to September 2020, comprised of 221 articles which four articles are chosen and entered into the final analysis.

Results:

The findings show the benefits of the early EN to guide nurses to start the EN as soon as possible after admitted to the Intensive Care Unit or when hemodynamic is stable in order to achieve a daily calorie target regarding the reduced hospitalization, duration of mechanical ventilation, morbidity, and mortality.

Conclusions:

The synthesized results show the early EN led by a nurse to address the specific needs and the vital role of nutritional support, and also drive the enteral feeding for critically ill patients to reach the calorie target goals in short times to enhance clinical outcomes.

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Most cited references 25

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Article: found

Trial of the route of early nutritional support in critically ill adults.

Danielle E Bear, Sheila E Harvey, Francesca Parrott … (2014)

Uncertainty exists about the most effective route for delivery of early nutritional support in critically ill adults. We hypothesized that delivery through the parenteral route is superior to that through the enteral route. We conducted a pragmatic, randomized trial involving adults with an unplanned admission to one of 33 English intensive care units. We randomly assigned patients who could be fed through either the parenteral or the enteral route to a delivery route, with nutritional support initiated within 36 hours after admission and continued for up to 5 days. The primary outcome was all-cause mortality at 30 days. We enrolled 2400 patients; 2388 (99.5%) were included in the analysis (1191 in the parenteral group and 1197 in the enteral group). By 30 days, 393 of 1188 patients (33.1%) in the parenteral group and 409 of 1195 patients (34.2%) in the enteral group had died (relative risk in parenteral group, 0.97; 95% confidence interval, 0.86 to 1.08; P=0.57). There were significant reductions in the parenteral group, as compared with the enteral group, in rates of hypoglycemia (44 patients [3.7%] vs. 74 patients [6.2%]; P=0.006) and vomiting (100 patients [8.4%] vs. 194 patients [16.2%]; P<0.001). There were no significant differences between the parenteral group and the enteral group in the mean number of treated infectious complications (0.22 vs. 0.21; P=0.72), 90-day mortality (442 of 1184 patients [37.3%] vs. 464 of 1188 patients [39.1%], P=0.40), in rates of 14 other secondary outcomes, or in rates of adverse events. Caloric intake was similar in the two groups, with the target intake not achieved in most patients. We found no significant difference in 30-day mortality associated with the route of delivery of early nutritional support in critically ill adults. (Funded by the United Kingdom National Institute for Health Research; CALORIES Current Controlled Trials number, ISRCTN17386141.).

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Optimal amount of calories for critically ill patients: depends on how you slice the cake!

Daren K Heyland, Naomi Cahill, Andrew G Day (2011)

The optimal amount of calories required by critically ill patients continues to be controversial. The objective of this study is to examine the relationship between the amount of calories administered and mortality. Prospective, multi-institutional audit. Three hundred fifty-two intensive care units from 33 countries. A total of 7,872 mechanically ventilated, critically ill patients who remained in the intensive care unit for at least 96 hrs. None. We evaluated the association between the amount of calories received and 60-day hospital mortality using various sample restriction and statistical adjustment techniques and demonstrate the influence of the analytic approach on the results. In the initial unadjusted analysis, we observe a significant association between increased caloric intake and increased mortality (odds ratio 1.28; 95% confidence interval 1.12-1.48 for patients receiving more than two-thirds of their caloric prescription vs. those receiving less than one-third of their prescription). Excluding days after permanent progression to oral intake attenuated the estimates of harm (unadjusted analysis: odds ratio 1.04; 95% confidence interval 0.90-1.20). Restricting the analysis to patients with at least 4 days in the intensive care unit before progression to oral intake and excluding days of observation after progression to oral intake resulted in a significant benefit to increased caloric intake (unadjusted odds ratio 0.73; 95% confidence interval 0.63-0.85). When further adjusting for both evaluable days and other important covariates, patients who received more than two-thirds of their caloric prescription are much less likely to die than those receiving less than one-third of their prescription (odds ratio 0.67; 95% confidence interval 0.56-0.79; p < .0001). When treated as a continuous variable, the overall association between the percent of the caloric prescription received and mortality is highly statistically significant with increasing calories associated with decreasing mortality (p < .0001). The estimated association between the amount of calories and mortality is significantly influenced by the statistical methodology used. The most appropriate available analyses suggest that attempting to meet caloric targets may be associated with improved clinical outcomes in critically ill patients.

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The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

Naomi Cahill, Daren K Heyland, Margot Lemieux … (2014)

Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances, and are designed to minimize practice variation, improve costs, and improve clinical outcomes. The Canadian Critical Care Practice Guidelines (CCPGs) were first published in 2003 and most recently updated in 2013. A total of 68 new randomized controlled trials were identified since the last version in 2009, 50 of them published between 2009 and 2013. The remaining articles were trials published before 2009 but were not identified in previous iterations of the CCPGs. For clinical practice guidelines to be useful to practitioners, they need to be up-to-date and be reflective of the current body of evidence. Herein we describe the process by which the CCPGs were updated. This process resulted in 10 new sections or clinical topics. Of the old clinical topics, 3 recommendations were upgraded, 4 were downgraded, and 27 remained the same. To influence decision making at the bedside, these updated guidelines need to be accompanied by active guideline implementation strategies. Optimal implementation strategies should be guided by local contextual factors including barriers and facilitators to best practice recommendations. Moreover, evaluating and monitoring performance, such as participating in the International Nutrition Survey of practice, should be part of any intensive care unit's performance improvement strategy. The active implementation of the updated CCPGs may lead to better nutrition care and improved patient outcomes in the critical care setting.

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Author and article information

Journal

Journal ID (nlm-ta): Iran J Nurs Midwifery Res

Journal ID (iso-abbrev): Iran J Nurs Midwifery Res

Journal ID (publisher-id): IJNMR

Title: Iranian Journal of Nursing and Midwifery Research

Publisher: Wolters Kluwer - Medknow (India )

ISSN (Print): 1735-9066

ISSN (Electronic): 2228-5504

Publication date Collection: Sep-Oct 2021

Publication date (Electronic): 02 September 2021

Volume: 26

Issue: 5

Pages: 392-398

Affiliations

[1 ] Faculty of Nursing, Mahidol University, Thailand

[2 ] Faculty of Nursing, HRH Princess Chulabron College of Medical Science, Chulaborn Royal Academy, Thailand

[3 ] Saint Louis University, Trudy Busch.Valentine School of Nursing, St.Louis, Missouri, USA

[4 ] Adult Nursing, Faculty of Nursing, Khon Kaen University, Acting Director, Research and Training Center for Enhancing Quality of Life of Working Age People, Thailand

Author notes

Address for correspondence: Miss. Apinya Koontalay, Faculty of Nursing, Mahidol University, 999 Phuttamonthon 4 Road, Salaya, Nakhon Pathom, Thailand. E-mail: apinya.koo@ 123456mahidol.ac.th

Article

Publisher ID: IJNMR-26-392

DOI: 10.4103/ijnmr.IJNMR_421_20

PMC ID: 8491827

PubMed ID: 34703776

SO-VID: e57a12b6-cc25-4f6a-9639-05e691331e38

License:

This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

Early Enteral Nutrition Met Calories Goals Led by Nurse on Improve Clinical Outcome: A Systematic Scoping Review

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Materials and Methods:

Results:

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Most cited references 25

Trial of the route of early nutritional support in critically ill adults.

Optimal amount of calories for critically ill patients: depends on how you slice the cake!

The Canadian critical care nutrition guidelines in 2013: an update on current recommendations and implementation strategies.

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