Ashley Eggleston, DNP, RN, CPNP-AC/PC
Pediatric Critical Care APP
Spectrum Health, United States
Disclosure information not submitted.
Elizabeth Prentice, DO
Pediatric Critical Care Intensivist
Helen DeVos Childrens Hospital, United States
Disclosure information not submitted.
Title: Utilizing a Protocol to Overcome Barriers to Feeding PICU Patients on Positive Pressure Ventilation
Introduction/Hypothesis: Barriers to feeding PICU patients on invasive and non-invasive positive pressure ventilation include the risk of feeding intolerance and aspiration pneumonitis. These barriers can delay the initiation of enteral nutrition and time to reach goal feeds. Enteral feeding protocols have been used in PICUs to improve feeding practices and optimize nutrition. The purpose of this study was to evaluate if implementing a feeding protocol impacted the time to initiate enteral nutrition and the time to reach goal feeds for patients on positive pressure ventilation.
Methods: A retrospective chart review was performed on all pediatric critical care patients requiring invasive and non-invasive mechanical ventilation admitted to Helen DeVos Children’s Hospital from 2019 to 2020. The feeding protocol was implemented in June 2019. Patients admitted prior to and after implementation were included in the pre and post protocol groups accordingly. Exclusion criteria included patients who were admitted post-operatively, required vasoactive medications, or were TPN dependent. The primary outcomes evaluated were the time from admission to initiation of enteral feeds and the time to achieve goal enteral feeds. The primary outcomes were analyzed via Wilcoxon Rank Sum.
Results: 292 patients were included in the review. 146 patients were included in both the pre and post-protocol groups. No significant difference in baseline demographics or PRISM score were noted between the groups. Median time from PICU admission to initiation of enteral feeding for the pre and post-protocol groups were 23 hours and 19 hours respectively (p=0.0334). The median time from initiation of feedings to goal nutrition for the two groups were 19 hours and 14 hours (p=0.0286). There was no significant difference between groups in PICU length of stay, days requiring mechanical ventilation, or feeding intolerance necessitating a change to post-pyloric feedings.
Conclusions: After implementing a feeding protocol in the PICU, there was a statistically significant decrease in the time from admission to starting feeds and the time from initiation to achieving goal nutrition. The feeding protocol was well tolerated in patients requiring positive pressure ventilation evidenced by no increase in adverse outcomes.