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

Critical Care

Lihua Zhou¹  Yun Sun²  Aijun Pan³  Juan Xing⁴  Yuanfei Li⁵  Wenming Liu⁶  Peiyang Gao⁷  Bin Zang⁸  for the Chinese Critcal Care Nutrition Trials Group (CCCNTG)⁹  Fachun Zhou^1,10  Dongpo Jiang^1,11  Xiangde Zheng^1,12  Xijing Zhang^1,13  Lu Ke^1,14  Zhihui Tong^1,14  Weiqin Li^1,14  Jiajia Lin^1,14  Xiaomei Chen^1,15  Xiaobo Huang^1,16  Feng Guo^1,17  Bo Yu^1,18  Zhongheng Zhang^1,19  Arthur R. H. van Zanten^2,20  Wei Xing^2,21  Yang Wang^2,22  Jiandong Lin^2,23  Yimin Li^2,24  Qiang Guo^2,25  Qindong Shi^2,26  Lixin Zhou^2,27  Zhigang Zhou^2,28  Min Yu^2,29  Chuming Fan^3,30  Rongguo Yu^3,31  Zhiguo Pan^3,32  Minjie Zhang^3,33  Cheng Sun^3,34  Liyun Zhao^3,35  Donglin Xu^3,36  Ming Wu^3,37  Fei Tong^3,38  Zhiyong Wang^3,39  Bingyu Qin^4,40  Qingshan Zhou^4,41  Zhiping Li^4,42  Jianbo Liu^4,43  Chunli Yang^4,44  Yingguang Xie^4,45  Biao Ma^4,46  Chuanyun Qian^4,47  Tingfa Zhou^4,48  Junli Sun^4,49  Yongjian Feng^5,50  Hailing Li^5,51  Aibin Cheng^5,52  Gordon S. Doig^5,53  Weixing Zhang^5,54  Lin Han^5,55  Liming Gu^5,56  Liandi Li^5,57  Feng Shan^5,57  Yafeng Liang^5,58  Yan Qu^5,59  Yuan Zong^6,60  Linxi Huang^6,61  Weidong Wu^6,62  Lei Wang^6,63  Dongwu Shi^6,64  Jinglan Wu^6,65  Xueyan Liu^6,66  Ping Chang^6,67  Zhijie He^6,68  Jun Liu^6,69  Fusen Zhang^7,70  Yang Liu^7,71  Min Shao^7,72  Kejian Qian^7,73  Yunlin Song^7,74  Rongqing Sun^7,75  Zhe Zhai^7,76  Yan Gao^7,77  Wei Li^7,78  An Zhang^7,79  Zhenyu Yang^8,80  Yuanqi Gong^8,81  Jian Yu^8,82  Qiuye Kou^8,83  Chuanyong Gong^8,84  Tao Chen^8,85  Shiying Yuan^8,86  Zhiqiang Zou^8,87  Zhongzhi Tang^8,88  Qiuhui Wang^8,89  Yuhang Ai^9,90  Yijun Deng^9,91  Baocai Fu^9,92  Zhaohui Zhang^9,93  Weihua Lu^9,94  Rumin Zhang^9,95 

[1] Affiliated Hospital of Inner Mongolia Medical College;Anhui Medical University Second Affiliated Hospital;Anhui Provincial Hospital;Benq Medical Center;Changsha Central Hospital Affiliated to University of South China;Changzhou No. 2 People’s Hospital Affiliated to Nanjing Medical University;Chengdu University of Traditional Chinese Medicine Affiliated Hospital;China Medical University Affiliated Shengjing Hospital;Chinese Critcal Care Nutrition Trials Group (CCCNTG);Chongqing Medical University First Affiliated Hospital;Daping Hospital, Army Medical University;Dazhou Central Hospital;Department of Anaesthesiology and Perioperative Medicine, Xijing Hospital, The Fourth Military Medical University;Department of Critical Care Medicine, Jinling Hospital;Department of Critical Care Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University;Department of Critical Care Medicine, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China;Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine;Department of Critical Care Medicine, the Second Xiangya Hospital of Central South University;Department of Emergency Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine;Department of Intensive Care Medicine, Gelderse Vallei Hospital;Department of Intensive Care Medicine, The Third Xiangya Hospital of Central South University;Department of Medical Research and Biometrics Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College;First Affiliated Hospital of Fujian Medical University;First Affiliated Hospital of Guangzhou Medical University;First Affiliated Hospital of Soochow University;First Affiliated Hospital of Xi’an Jiao Tong University;First People’s Hospital of Foshan;First People’s Hospital of Kunming;First People’s Hospital of Yichang;First People’s Hospital of Yunnan;Fujian Provincial Hospital;General Hospital of Southern Theatre Command;General ICU, Jinan University First Affiliated Hospital;Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences;Guangdong Second Traditional Chinese Medicine Hospital;Guangzhou First People’s Hospital, School of Medicine, South China University of Technology;Health Science Center, The Second People’s Hospital of Shenzhen, First Affiliated Hospital of Shenzhen University;Hebei Medical University Second Affiliated Hospital;Hebei Medical University, Third Affiliated Hospital;Henan Provincial People’s Hospital;Hubei Provincial People’s Hospital;Hunan Provincial People’s Hospital;Inner Mongolia People’s Hospital;Jiangxi Provincial People’s Hospital;Jining First People’s Hospital;Jining Medical College Affiliated Hospital;Kuming Medical University First Affiliated Hospital;Linyi City People Hospital;Luoyang Central Hospital Affiliated To Zhengzhou University;Neurosurgical ICU, Jinan University First Affiliated Hospital;No.971 Hospital of People’s Liberation Army Navy;North China University of Science and Technology Affiliated Hospital;Northern Clinical School, Royal North Shore Hospital, University of Sydney;Peking University Shenzhen Hospital;People’s Hospital of Guangxi Zhuang Autonomous Region;People’s Hospital of Yuxi City;Qindao University Medical College Affiliated Hospital;Qindao University Medical College Affiliated Yantai Yuhuangding Hospital;Qingdao Municipal Hospital Group;Shaanxi Provincial People’s Hospital;Shantou University Medical College First Affiliated Hospital;Shanxi Bethune Hospital;Shanxi Medical University First Affiliated Hospital;Shanxi Provincial People’s Hospital;Shenzhen Nanshan People’s Hospital;Shenzhen People’s Hospital;Southern Medical University Zhujiang Hospital;Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University;Suzhou Municipal Hospital;Tai’an City Central Hospital;Tangshan Gongren Hospital;The First Affiliated Hospital of Anhui Medical University;The First Affiliated Hospital of Nanchang University;The First Affiliated Hospital of Xinjiang Medical University;The First Affiliated Hospital of Zhengzhou University;The Fourth Hospital of Harbin Medical University;The General Hospital of Shenyang Military;The People’s Hospital of Fujian Province;The Second Affiliated Hospital of Chongqing Medical University;The Second Affiliated Hospital of Harbin Medical University;The Second Affiliated Hospital of Nanchang University;The Second Hospital of Dalian Medical University;The Sixth Affiliated Hospital, Sun Yat-Sen University;Tianjing Hospital of Integration of Chinese and Western Medicine;Tropical Clinical Trials Unit, Department of Clinical Sciences, Liverpool School of Tropical Medicine;Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology;Union Hospital of Fujian Medical University;Wuhan General Hospital of Guangzhou Military Region;Wuxi People’s Hospital;Xiangya Hospital Central South University;Yancheng First People’s Hospital;Yantai Mountain Hospital;Yichang Central People’s Hospital;Yijishan Hospital of Wannan Medical College;Zibo Central Hospital;

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

DOI  :  10.1186/s13054-022-03921-5

来源: DOAJ

【 摘 要 】

Abstract 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.

【 授权许可】

Unknown