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Feeding Guidelines Improve Nutritional Support — But Not Clinical Outcomes — in the ICU
Guidelines lead to earlier nutritional support in the ICU — but not necessarily improved clinical outcomes — according to a JAMA report.
Researchers developed evidence-based guidelines for nutritional support of ICU patients, and then randomized 27 hospitals to either implement the guidelines or follow their current feeding protocols for 20 weeks. Outcomes were assessed in some 1100 ICU patients who were not eligible for oral nutrition.
Patients in guideline hospitals received parenteral or enteral feedings earlier than did those in control hospitals (mean delay, 18 vs. 33 hours), and they were also fed on more days. However, the two groups did not differ in hospital discharge mortality or length of ICU stay.
Editorialists, speculating on the lack of clinical benefit in the guideline group, note that "feeding improved but perhaps not enough." They conclude that creating and implementing evidence-based nutrition guidelines remains an "achievable and worthwhile pursuit."
LINK(S):
JAMA article (Free abstract; full text requires subscription)
JAMA editorial (Subscription required)
Published in Physician's First Watch December 17, 2008
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