(415) Well Fed: Enteral Nutrition Strategies in the Critically Ill

Introduction: Inadequate energy provision is associated with poor outcomes in critically ill patients. Two options for nutrition delivery in the ICU are parenteral and enteral nutrition (EN): enteral being the preferred method. A volume-based feeding strategy prescribes a daily volume, and the rate is titrated to achieve said target within a 24-hour period. A rate-based feeding strategy uses a fixed hourly rate and is the current standard for EN delivery. We hypothesize that patients who receive volume-based feeding are more likely to meet their daily EN goals compared to a rate-based approach, and therefore have improved clinical outcomes.

Methods: This retrospective, single-center quality improvement study included patients admitted to medical and surgical ICUs from March 2020 to April 2023. Patients from nursing facilities, on long-term EN prior to admission, transplant patients, and patients also on parenteral nutrition during the same hospitalization were excluded. The primary outcome was the percentage of goal-volume-intake received by patients throughout their admission. Secondary outcomes included hospital and ICU length of stay, duration of mechanical ventilation, and hospital-acquired pressure injuries and infections. To account for multiple comparisons, p-values were adjusted using the Bonferroni correction.

Results: Among 100 patients (rate-based = 72, volume-based = 14, mixed = 14), those on volume-based feeds met a higher percent of their intake goal (74.64%) compared to patients with rate-based (64.07%) or mixed feeds (70.07%). However, this trend was not statistically significant (p = 0.116), even when comparing only volume-based to rate-based patients (adj. p = 0.068). There were also no statistically significant differences among the groups in hospital and ICU length of stay (p = 0.547, 0.218 respectively), mechanical ventilation days (p = 0.184), hospital-acquired pressure injuries (p = 0.449), or infections (p = 0.224).

Conclusions: While our study shows no statistically significant difference in percent goal volume intake between volume and rate-based feeding, there is a trend towards higher percent intake among those who received volume-based feeding. Its impact on clinical outcomes may be further delineated in a larger study population.