The implementation of a nutrition protocol in a surgical intensive care unit; a randomized controlled trial at a tertiary care hospital

BACKGROUND: Malnutrition in critically ill patients is linked with significant mortality and morbidity. However, it remains controversial whether nutrition therapy protocols are effective in improving clinical outcomes. The present study aimed to evaluate the effectiveness of a surgical ICU nutrition protocol, and to compare the hospital mortality, hospital LOS, and ICU LOS of protocol and non-protocol groups. METHODS: A randomized controlled trial was conducted at the Surgical ICU, Siriraj Hospital. The nutrition administration of the control group was at the discretion of the attending physicians, whereas that of the intervention group followed the “Siriraj Surgical ICU Nutrition Protocol”. Details of the demographic data, nutritional data, and clinical outcomes were collected. RESULTS: In all, 170 patients underwent randomization, with 85 individuals each in the protocol and non-protocol groups. More than 90% of the patients in both groups were at risk of malnutrition, indicated by a score of ≥ 3 on the Nutritional Risk Screening 2002 tool. The average daily calories of the 2 groups were very similar (protocol group, 775.4±342.2 kcal vs. control group, 773.0±391.9 kcal; p = 0.972). However, the median time to commence enteral nutrition was shorter for the protocol group (1.94 days) than the control group (2.25 days; p = 0.503). Enteral nutrition was provided within the first 48 hours to 53.7% of the protocol patients vs. 47.4% of the control patients (p = 0.589). In addition, a higher proportion of the protocol patients (36.5%) reached the 60% calorie-target on Day 4 after admission than that for the non-protocol group (25.9%; p = 0.136). All other clinical outcomes and nutrition-related complications were not significantly different. CONCLUSIONS: The implementation of the nutrition protocol did not improve the feeding effectiveness or clinical outcomes as compared to usual nutrition management practices of the Surgical ICU.