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Volume Based Feeding Versus Rate Based Feeding in the Critically Ill: A UK Study

Bharal, M., Morgan, S. ORCID: 0000-0002-7573-4290, Husain, T., Hilari, K. ORCID: 0000-0003-2091-4849, Proctor, C., Harrison, K. ORCID: 0000-0003-0271-5272, Bassett, P. and Culkin, A. (2019). Volume Based Feeding Versus Rate Based Feeding in the Critically Ill: A UK Study. Journal of the Intensive Care Society,

Abstract

Nutrition support is an essential part of treatment in patients requiring intensive care. Timely provision of greater energy and protein intake is associated with lower mortality and a faster time to discharge alive [1, 2]. However, underfeeding in intensive care patients is commonplace and multi-factorial [3]. In response to stress, underfeeding can lead to malnutrition and poor clinical outcomes, including increased mechanical ventilation days, infectious complications, length of stay (LOS) in the Intensive Care Unit (ICU) and in hospital, with an increase in associated healthcare costs [4-8].

Enteral nutrition (EN) remains the preferred route of feeding in ICUs, providing both nutritional and non-nutritional benefits [9-12]. However, there is currently insufficient evidence for the optimal EN delivery method in the literature for intensive care patients, with options including Rate Based Feeding (RBF) or bolus feeding [13, 14]. Frequent interruptions to EN including routine fasting for procedures and investigations exacerbate underfeeding in ICU patients [15, 16] and recent studies have demonstrated that RBF is ineffective in addressing this issue [17-20]. Despite this, RBF remains the most common method of EN delivery throughout ICUs in Europe. The recent International Nutrition Survey (INS, 2014/15), demonstrated that adequacy of energy and protein in enterally fed ICU patients in Europe was 58% and 54% respectively (unpublished data; Darren Heyland, personal communication, 2017).

A Volume Based Feeding (VBF) approach has been recommended to address the challenges of frequent interruptions and optimise the delivery of EN [12,14]; designed to adjust the infusion rate to make up for daily interruptions in delivery, enabling a greater volume of EN to be delivered compared to a fixed hourly RBF [18]. This recommendation for VBF is based on studies in North America [18-21]. To date there are no studies evaluating VBF alone and its effect on EN delivery or clinical outcomes outside of North American healthcare institutes. Although the practice of intensive care medicine is universal in most countries, there can be significant differences in healthcare and populations in this already heterogeneous patient group; these previous VBF studies may not be generalisable to other intensive care populations where differing health systems, barriers, patient characteristics and priorities towards nutrition might present [22].

So far there has been no study in the United Kingdom (UK) that addresses whether VBF is a safe and more effective method than RBF in improving energy and protein delivery in mechanically ventilated ICU patients. We hypothesised that VBF would improve energy and protein delivery without deleterious effects on glycaemic control or gastrointestinal tolerance and subsequently, may improve clinical outcome.

Publication Type: Article
Additional Information: This is the accepted version of the article, Bharal, M., Morgan, S. , Husain, T., Hilari, K. , Proctor, C., Harrison, K. , Bassett, P. and Culkin, A. (2019). Volume Based Feeding Versus Rate Based Feeding in the Critically Ill: A UK Study. Journal of the Intensive Care Society, to be published in Journal of the Intensive Care Society.
Subjects: R Medicine
R Medicine > RT Nursing
Departments: School of Health Sciences > Language & Communication Science
URI: http://openaccess.city.ac.uk/id/eprint/21987
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