Improving Enteral Delivery Through the Adoption of the “Feed Early Enteral Diet Adequately for Maximum Effect (FEED ME)” Protocol in a Surgical Trauma ICU

Abstract

A change in standard of practice to an EN volume-based feeding approach in a STICU led to a significant improvement in adequacy of calories and protein delivered, with only a slight increase in diarrhea.

ASPEN Safe Practices for Enteral Nutrition Therapy

“…The implementation of enteral feeding protocols may improve energy, protein, and fluid delivery to ICU patients who experience interruptions in EN delivery due to unavoidable procedures (reintubation/extubation, bedside procedures involving the GI tract or airway, and imaging studies) 16 , 17 . The administration of large volumes of EN to compensate for EN that was missed during procedures can place patients at risk for intolerance of EN 18 .…”

Should early enteral nutrition be used in the trauma intensive care unit?

“…These are the enhanced protein-energy provision via the enteral route in critically ill patients (PEP uP) 12 and the Feed Early Enteral Diet adequately for Maximum Effect (FEED ME) 13 protocols. Volume-based goals drive the new aggressive approaches.…”

“…If the patient falls behind, the hourly rate is adjusted to ensure that the total intake is met within a given 24-hour period. 12,13 Successful implementation of the PEP uP protocol in mechanically ventilated ICU patients resulted in significantly more energy and protein delivered per 24 hours. No differences in gastrointestinal side-effects were experienced when compared to the traditional approach.…”

“…Significantly more energy and protein intake was also reported, with similar episodes of emesis and raised gastric residual volumes between the groups. 13 One of the differences between the PEP up and FEED ME protocols is that FEED ME is implemented once patients have reached the goal rate of enteral nutrition, as opposed to the PEP uP protocol which entails feeding immediately that the enteral route can be used. A make-up component is calculated in both protocols to ensure that full daily needs are met.…”

“…However, both protocols seem to be successful in ensuring a better intake without sacrificing gastrointestinal tolerance. 12,13 A few general feeding recommendations which can be applied to critically ill trauma patients include: [1][2][3][5][6][7] • Starting enteral nutrition as soon as possible after ICU admission, increasing it according to gut tolerance, and administering prokinetics, if needed.…”