Implementing a multifaceted tailored intervention to improve nutrition adequacy in critically ill patients: results of a multicenter feasibility study

Table 5 Change in nutrition practice indicators

Nutrition practice	Before (2009)	After (2011)	Change	Range		P value^e
	(n = 140)	(n = 138)		Min	Max
Adequacy of calories from total nutrition^a (%)	42.9 (29.6)	49.0 (31.2)	6.1	–1.6	18.0	0.23^f
Adequacy of protein from total nutrition (%)	40.7 (31.6)	45.1 (31.8)	4.4	–8.3	18.2	0.67^f
Adequacy of calories from EN (%)	36.1 (29.7)	37.6 (29.1)	1.4	–5.5	8.8	0.76^f
	38.7 3(1.5)	40.3 (31.0)	1.6	–8.3	12.2	0.75^f
Patients who achieved >80% adequacy from calories within 72 hours of ICU admission^c	36 (26)	44 (32)	6	–15	30	0.45
Type of nutrition
EN only	98 (70)	100 (72)	2	–12	15
PN only	6 (4)	8 (6)	2	–5	5
EN + PN	12 (9)	10 (7)	–2	–5	1
None	24 (17)	20 (15)	–2	–15	12
EN initiated within 48 hours^b	71 (65)	77 (75)	10	–13	38	0.16
Time from ICU admission to initiation of EN (hours)^b	40.3 (36.5)	39.8 (43.7)	–0.5	–25	23	0.94
Time from start of EN to >80% adequacy of calories (days)^c	6.8 (3.8, 12)	5.8 (2.8,12)	–1.0	–7.6	1.1
Use of motility agents in patients with GRV^d	7 (50)	11 (58)	8	–50	2	0.88
Use of small bowel feeding in patients with GRV^d	0 (0)	0 (0)	0	0	0	N/A
Head of bed elevation (degrees)	34.0 (17.2)	32.0 (5.8)	–2.0	–6.7	5.4	0.59
Morning blood glucose > 10 mmol/l (patient-days)	165 (16)	162 (15)	–1	–18	6	0.68^g

Data presented as mean (standard deviation), n (%) or median (interquartile range). EN, enteral nutrition; GRV, gastric residual volume; Max, maximum; Min, minimum; N/A, strategy employed at single site only; PN, parenteral nutrition. ^aIncluded propofol, EN, and appropriate PN. ^bOnly included patients who ever received EN. ^cBased on data indicating that achieving >80% adequacy of calories is associated with decreased mortality[32]. ^dOnly included patients who ever had high GRV. ^eP values account for ICU level clustering, using random ICU and ICU by year effects for continuous outcomes and the Rao–Scott chi-squared method clustering by ICU for categorical outcomes. ^fAdjusted for evaluable nutrition days. ^gP values account for ICU and patient level clustering using the Rao–Scott chi-squared method.

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