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

Background & aims: Critical 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. Methods: In 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. Results: The 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. Conclusions: The 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.