Date of Award

Summer 6-17-2014

Degree Type

Thesis

Degree Name

Master of Science (MS)

Department

Nutrition

First Advisor

Sarah T. Henes, PhD, RD, LD

Second Advisor

Ashley DePriest, MS, RD, LD

Third Advisor

Jessica D. Todd, MS, RD, LD

Fourth Advisor

Kathy Taylor, MS, RD, LD

Abstract

ABSTRACT

Comparing Early Enteral Nutrition AmONG Medical, Burn, Surgical/Trauma, and Neurocritical Intensive Care Units and its Effect on Length of Stay

By

Kelsey Spinks

Background: Current research supports that early enteral nutrition (EEN), or enteral nutrition delivered within 48 hours of admission, may reduce infection, incidence of pneumonia, mortality, and time that critical care patients spend on the ventilator. EEN may also decrease intensive care unit (ICU) length of stay. With one day in the ICU costing an estimated $14,462, length of stay becomes a financial concern for hospitals that care for uninsured or underinsured patients. Most studies that examine the effect of EEN on length of stay lump all critical care patients into one group or will only examine one ICU population at a time.

Objective: To examine the effect of EEN on length of stay for critical care patients in four adult intensive care units to include: burn, neurocritical, medical, and surgical/trauma ICUs in a large urban teaching hospital.

Methods: A retrospective chart review was conducted for patients admitted between September 2012 and February 2014 in each of the four adult ICUs. Statistical analyses for nonparametric data were conducted using SPSS 21.

Sample Description: The median age of the 89 patients was 55 years. The median BMI was 28. There were 61 males and 28 females. In the surgical/trauma ICU, the median age was 48 years, BMI was 25, and there were 15 males and 8 females. In the medical ICU, the median age was 57 years, BMI was 32, and there were 17 males and 6 females. In the burn ICU, the median age was 40 years, BMI was 28, and there were 14 males and 5 females. In the neurocritical ICU, the median age was 62 years, BMI was 27, and there were 15 males and 9 females.

Results: There was a significant but weak positive correlation between the time to initiation of enteral nutrition (EN) and ICU length of stay in the surgical ICU (p=0.04), medical ICU (p=0.03) and neurocritical ICU (p=0.04). A significant difference (p=0.03) was found in ICU length of stay between the medical ICU patients who were fed early (within 48 hours of admission) versus those who were fed late (after 48 hours of admission). Patients fed late had a longer ICU length of stay than those who were fed early. There was a significantly earlier time in the initiation of EN (p<0.001) between the units who have an RD rounding daily (burn and neurocritical) and the units that did not (surgical and medical).

Conclusions: EEN is significantly associated with shorter ICU lengths of stay in surgical, medical, and neurocritical populations. Even if EEN does not decrease length of stay in a particular population, it could still be beneficial for other patient outcomes, like reduced mortality, lower incidence of pneumonia, and shorter time spent on the ventilator. The ICU dietitian plays an important role in advocating for EEN in those patients who are medically ready for it. In terms of best practice, critical care RDs have a valuable opportunity to establish their niche as the nutrition expert on the interdisciplinary care team by incorporating medical rounds in to their daily practice.

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