Effect of a nurse-driven feeding algorithm and the institution of a nutritional support team on energy and macronutrient intake in critically ill children

SummaryBackground & aimsCritical care providers fail to meet patients’ nutritional demands particularly during the first days of PICU stay. We hypothesize that the introduction of a feeding algorithm combined with a nutritional support team (NST) can improve nutrition delivery.MethodsIn our PICU we compared the delivered percentages of goals for energy and macronutrients during the first 10 days of admission before and after the introduction of a feeding algorithm and NST. Patients with length of stay > 3 days and mechanical ventilation were included. The algorithm was based on early and aggressively incremental, nurse-driven enteral feeding with additional parenteral nutrition, if necessary. The NST reviewed and adjusted the nutrition regimens once a week and on demand.ResultsThe percentages of enteral nutrition delivered on day 1 doubled from 40% to 78% (p < 0.01), and increased from 60% to 92% on day 2 (p < 0.01) without increase in adverse gastrointestinal events, compared to the control period. More than 85% of nutritional targets were reached on day 3 compared to on day 4 before the protocol.ConclusionsThe introduction of an early and aggressive, nurse-driven nutrition protocol, together with an NST, is an effective and safe tool to increase nutrition delivery on a PICU.