Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial (vol 26, 46, 2022)

被引：2

作者：

Ke, Lu ^{[1
,2
]}

Lin, Jiajia ^{[1
]}

Doig, Gordon S. ^{[3
]}

van Zanten, Arthur R. H. ^{[4
]}

Wang, Yang ^{[5
,6
]}

Xing, Juan ^{[7
]}

Zhang, Zhongheng ^{[8
]}

Chen, Tao ^{[9
]}

Zhou, Lixin ^{[10
]}

Jiang, Dongpo ^{[11
]}

Shi, Qindong ^{[12
]}

Lin, Jiandong ^{[13
]}

Liu, Jun ^{[14
]}

Cheng, Aibin ^{[15
]}

Liang, Yafeng ^{[16
]}

Gao, Peiyang ^{[17
]}

Sun, Junli ^{[18
]}

Liu, Wenming ^{[19
]}

Yang, Zhenyu ^{[20
]}

Zhang, Rumin ^{[21
]}

Xing, Wei ^{[22
]}

Zhang, An ^{[23
]}

Zhou, Zhigang ^{[24
]}

Zhou, Tingfa ^{[25
]}

Liu, Yang ^{[26
]}

Tong, Fei ^{[27
]}

Wang, Qiuhui ^{[28
]}

Pan, Aijun ^{[29
]}

Huang, Xiaobo ^{[30
]}

Fan, Chuming ^{[31
]}

Lu, Weihua ^{[32
]}

Shi, Dongwu ^{[33
]}

Wang, Lei ^{[34
]}

Li, Wei ^{[35
]}

Gu, Liming ^{[36
]}

Xie, Yingguang ^{[37
]}

Sun, Rongqing ^{[38
]}

Guo, Feng ^{[39
]}

Han, Lin ^{[40
]}

Zhou, Lihua ^{[41
]}

Zheng, Xiangde ^{[42
]}

Shan, Feng ^{[43
]}

Liu, Jianbo ^{[44
]}

Ai, Yuhang ^{[45
]}

Qu, Yan ^{[46
]}

Li, Liandi ^{[43
]}

Li, Hailing ^{[47
]}

Pan, Zhiguo ^{[48
]}

Xu, Donglin ^{[49
]}

Zou, Zhiqiang ^{[50
]}

机构：

[1] Nanjing Univ, Jinling Hosp, Sch Med, Dept Crit Care Med, 305 Zhongshan East Rd, Nanjing 210000, Jiangsu, Peoples R China

[2] Nanjing Univ, Natl Inst Healthcare Data Sci, Nanjing, Peoples R China

[3] Univ Sydney, Royal North Shore Hosp, Northern Clin Sch, Sydney, NSW, Australia

[4] Gelderse Vallei Hosp, Dept Intens Care Med, Willy Brandtlaan 10, NL-6716 RP Ede, Netherlands

[5] Chinese Acad Med Sci & Peking Union Med Coll, Dept Med Res, Beijing, Peoples R China

[6] Chinese Acad Med Sci & Peking Union Med Coll, Natl Ctr Cardiovasc Dis, Biometr Ctr, State Key Lab Cardiovasc Dis,Fuwai Hosp, Beijing, Peoples R China

[7] Benq Med Ctr, Nanjing, Peoples R China

[8] Zhejiang Univ, Sir Run Run Shaw Hosp, Dept Emergency Med, Sch Med, Hangzhou, Peoples R China

[9] Univ Liverpool Liverpool Sch Trop Med, Dept Clin Sci, Trop Clin Trials Unit, Liverpool L3 5QA, Merseyside, England

[10] First Peoples Hosp Foshan, Foshan, Peoples R China

[11] Army Med Univ, Daping Hosp, Chongqing, Peoples R China

[12] Xi An Jiao Tong Univ, Affiliated Hosp 1, Xian, Peoples R China

[13] Fujian Med Univ, Affiliated Hosp 1, Fuzhou, Peoples R China

[14] Suzhou Municipal Hosp, Suzhou, Peoples R China

[15] North China Univ Sci & Technol, Affiliated Hosp, Tangshan, Peoples R China

[16] Qindao Univ, Coll Med, Affiliated Yantai Yuhuangding Hosp, Yantai, Peoples R China

[17] Chengdu Univ Tradit Chinese Med, Affiliated Hosp, Chengdu, Peoples R China

[18] Zhengzhou Univ, Luoyang Cent Hosp, Luoyang, Peoples R China

[19] Nanjing Med Univ, Changzhou Peoples Hosp 2, Changzhou, Jiangsu, Peoples R China

[20] Harbin Med Univ, Affiliated Hosp 2, Harbin, Peoples R China

[21] Zibo Cent Hosp, Zibo, Peoples R China

[22] Cent South Univ, Xiangya Hosp 3, Dept Intens Care Med, Changsha, Peoples R China

[23] Chongqing Med Univ, Affiliated Hosp 2, Chongqing, Peoples R China

[24] First Peoples Hosp Kunming, Kunming, Yunnan, Peoples R China

[25] Linyi City People Hosp, Linyi, Shandong, Peoples R China

[26] Tangshan Gongren Hosp, Tangshan, Peoples R China

[27] Hebei Med Univ, Affiliated Hosp 2, Shijiazhuang, Hebei, Peoples R China

[28] Wuxi Peoples Hosp, Wuxi, Jiangsu, Peoples R China

[29] Anhui Prov Hosp, Hefei, Peoples R China

[30] Univ Elect Sci & Technol China, Sichuan Prov Peoples Hosp, Dept Crit Care Med, Chengdu 610072, Peoples R China

[31] First Peoples Hosp Yunnan, Kunming, Yunnan, Peoples R China

[32] Yijishan Hosp, Wannan Med Coll, Wuhu, Peoples R China

[33] Shanxi Prov Peoples Hosp, Taiyuan, Peoples R China

[34] Shanxi Med Univ, Affiliated Hosp 1, Taiyuan, Peoples R China

[35] Peoples Hosp Fujian Prov, Fuzhou, Peoples R China

[36] Peoples Hosp Yuxi City, Yuxi, Peoples R China

[37] Jining First Peoples Hosp, Jining, Peoples R China

[38] Zhengzhou Univ, Affiliated Hosp 1, Zhengzhou, Peoples R China

[39] Zhejiang Univ, Sir Run Run Shaw Hosp, Dept Crit Care Med, Sch Med, Hangzhou, Peoples R China

[40] Peoples Hosp Guangxi Zhuang Autonomous Reg, Nanning, Peoples R China

[41] Affiliated Hosp, Inner Mongolia Med Coll, Hohhot, Peoples R China

[42] Dazhou Cent Hosp, Dazhou, Peoples R China

[43] Qindao Univ, Coll Med, Affiliated Hosp, Qingdao, Peoples R China

[44] Inner Mongolia Peoples Hosp, Hohhot, Peoples R China

[45] Cent South Univ, Xiangya Hosp, Changsha, Peoples R China

[46] Qingdao Municipal Hosp Grp, Qingdao, Peoples R China

[47] 971 Hosp Peoples Liberat Army Navy, Qingdao, Peoples R China

[48] Gen Hosp Southern Theatre Command, Guangzhou, Peoples R China

[49] South China Univ Technol, Guangzhou Peoples Hosp 1, Sch Med, Guangzhou, Guangdong, Peoples R China

[50] Fujian Med Univ, Union Hosp, Fuzhou, Peoples R China

来源：

CRITICAL CARE | 2022年 / 26卷 / 01期

关键词：

Cluster-randomized trial; Evidence-based guideline; Intensive care unit; Nutrition therapy;

D O I：

10.1186/s13054-022-03982-6

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background: Previous cluster-randomized controlled trials evaluating the impact of implementing evidence-based guidelines for nutrition therapy in critical illness do not consistently demonstrate patient benefits. A large-scale, sufficiently powered study is therefore warranted to ascertain the effects of guideline implementation on patient-centered outcomes. Methods: We conducted a multicenter, cluster-randomized, parallel-controlled trial in intensive care units (ICUs) across China. We developed an evidence-based feeding guideline. ICUs randomly allocated to the guideline group formed a local "intervention team", which actively implemented the guideline using standardized educational materials, a graphical feeding protocol, and live online education outreach meetings conducted by members of the study management committee. ICUs assigned to the control group remained unaware of the guideline content. All ICUs enrolled patients who were expected to stay in the ICU longer than seven days. The primary outcome was all-cause mortality within 28 days of enrollment. Results: Forty-eight ICUs were randomized to the guideline group and 49 to the control group. From March 2018 to July 2019, the guideline ICUs enrolled 1399 patients, and the control ICUs enrolled 1373 patients. Implementation of the guideline resulted in significantly earlier EN initiation (1.20 vs. 1.55 mean days to initiation of EN; difference − 0.40 [95% CI − 0.71 to − 0.09]; P = 0.01) and delayed PN initiation (1.29 vs. 0.80 mean days to start of PN; difference 1.06 [95% CI 0.44 to 1.67]; P = 0.001). There was no significant difference in 28-day mortality (14.2% vs. 15.2%; difference − 1.6% [95% CI − 4.3% to 1.2%]; P = 0.42) between groups. Conclusions: In this large-scale, multicenter trial, active implementation of an evidence-based feeding guideline reduced the time to commencement of EN and overall PN use but did not translate to a reduction in mortality from critical illness. Trial registration: ISRCTN, ISRCTN12233792. Registered November 20th, 2017. © The Author(s) 2022.

引用

页数：2

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