ORIGINAL RESEARCH article
Front. Med.
Sec. Intensive Care Medicine and Anesthesiology
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1562937
ENTERAL FEEDING PROTOCOL: A QUALITY IMPROVEMENT PROJECT TO IMPROVE FEEDING INTERRUPTION AND CLINICAL OUTCOMES IN TERTIARY INTENSIVE CARE UNIT
Provisionally accepted
Boon Hui Ng1
Aliza Mohamad Yusof2*
Wan Rahiza Wan Mat2
Rufinah Teo2
Azarinah Izaham2
Khazrul Nizar Kader2
Jaafar Md Zain2Siti Nidzwani Mohamad Mahdi2
Qurratu Aini Musthafa2- 1Department of Anaesthesia and Intensive Care, Duchess of Kent Sandakan Hospital, Malaysia, Sandakan, Malaysia
- 2Department of Anaesthesiology and Intensive Care, Hospital Canselor Tuanku Muhriz, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Purpose: Evaluation of the effectiveness of feeding protocol in improving feeding interruption (FI) and clinical outcome in critically ill patients. Material and methods: This were a single center, retrospective and prospective cohort study design evaluating the nutritional characteristics and adequacy, the causes and clinical outcomes of FI, pre and post-feeding protocol implementation. The risk factor for ICU mortality was also identified. Results: Four hundred thirty patients were included, 217 in the pre-protocol and 213 in post-protocol group. After protocol implementation, energy and protein intake significantly improved and achieved total target nutrition. The post-protocol group were prescribed more energy dense formula (29.0% vs 55.4%, p < 0.001), protein supplement (27.6% vs 56.3%, p < 0.001), and prokinetic agent (38.7% vs 48.8%, p = 0.03). There was no difference in the duration of feeding interruption (28 hours vs 30 hours, p = 0.60). Implementation of feeding protocol did not affect ICU mortality (OR 0.508, CI 0.250-1.032, p = 0.06). The mortality predictors were SOFA score, underweight and illness related FI episode. Conclusion: Implementation of feeding protocol improved feeding strategies and overall nutritional intake; however, it did not improve FI. Illness related FI was associated with reduction in survival of critically ill patients.
Keywords: Enteral Nutrition, feeding protocol, Intensive Care Units, Feeding interruption, ICU outcome, Critical Care
Received: 18 Jan 2025; Accepted: 12 Sep 2025.
Copyright: © 2025 Ng, Mohamad Yusof, Wan Mat, Teo, Izaham, Kader, Md Zain, Mohamad Mahdi and Musthafa. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aliza Mohamad Yusof, alizamyusof@gmail.com
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.