第二代肠内营养给药方法与策略（英文ppt）.ppt

Other Strategies to Maximize the Benefits and Minimize the Risks of EN If intragastric feeds not tolerated, problems with high GRVs refractory to motility agents, we recommend small bowel feeding tube Hey Dr. can we get that small bowel tube in place so I can get their volume of EN in asap! They may need a gentle reminder to get the small bowel feeding tube in place A Change to Nursing Report Adequacy of Nutrition Support = 24 hour volume of EN received Volume prescribed to meet caloric requirements in 24 hours Please report this % on rounds as part of the GI systems report Evaluation Plan Purpose: to evaluate the safety and acceptibility of this new protocol Before (n=20) and after (n=30) study Consecutive eligible mechanically ventilated patients 3days Compared nutritional outcomes At the end of each nursing shift, will ask the nurse the following 4 questions: Evaluation Questions Were you exposed to the educational interventions and if so, how useful did you find them? Did you encounter any situation or event that in your opinion, compromised the patient’s safety? Overall, how acceptable was this new protocol (1-totally unacceptable; 10- totally acceptable) Any suggestions for improving the protocol? RESULTS Nurses’ Ratings of Acceptability After Group Mean (range) 24 hour volume based target 7.0 (1-10) Starting at a high hourly rate 5.9 (1-10) Starting motility agents right away 7.4 (1-10) Starting protein supplements right away 7.6 (1-10) Acceptability of the overall protocol 7.1 (1-10) 1=totally unacceptable and 10=totally acceptable No adverse events noted by Nurses Results Before After P value Patient’s initial prescription NPO trophic feeds 25 ml/ hr 24 volume based feeds Day 1 use of motility agents Day 1 use of Protein supplements Complications Vomiting Regurgitation Witnessed Aspiration VAP 15.0% 10.0% 10.0% 25% 6.7% 0 0 13.2% NS The Efficacy of Enhanced Protein-Energy Provision via the Enteral Route in Critic