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

Lu Ke; Jiajia Lin; Gordon S. Doig; Arthur R. H. van Zanten; Yang Wang; Juan Xing; Zhongheng Zhang; Tao Chen; Lixin Zhou; Dongpo Jiang; Qindong Shi; Jiandong Lin; Jun Liu; Aibin Cheng; Yafeng Liang; Peiyang Gao; Junli Sun; Wenming Liu; Zhenyu Yang; Rumin Zhang; Wei Xing; An Zhang; Zhigang Zhou; Tingfa Zhou; Yang Liu; Fei Tong; Qiuhui Wang; Aijun Pan; Xiaobo Huang; Chuming Fan; Weihua Lu; Dongwu Shi; Lei Wang; Wei Li; Liming Gu; Yingguang Xie; Rongqing Sun; Feng Guo; Lin Han; Lihua Zhou; Xiangde Zheng; Feng Shan; Jianbo Liu; Yuhang Ai; Yan Qu; Liandi Li; Hailing Li; Zhiguo Pan; Donglin Xu; Zhiqiang Zou; Yan Gao; Chunli Yang; Qiuye Kou; Xijing Zhang; Jinglan Wu; Chuanyun Qian; Weixing Zhang; Minjie Zhang; Yuan Zong; Bingyu Qin; Fusen Zhang; Zhe Zhai; Yun Sun; Ping Chang; Bo Yu; Min Yu; Shiying Yuan; Yijun Deng; Liyun Zhao; Bin Zang; Yuanfei Li; Fachun Zhou; Xiaomei Chen; Min Shao; Weidong Wu; Ming Wu; Zhaohui Zhang; Yimin Li; Qiang Guo; Zhiyong Wang; Yuanqi Gong; Yunlin Song; Kejian Qian; Yongjian Feng; Baocai Fu; Xueyan Liu; Zhiping Li; Chuanyong Gong; Cheng Sun; Jian Yu; Zhongzhi Tang; Linxi Huang; Biao Ma; Zhijie He; Qingshan Zhou; Rongguo Yu; Zhihui Tong; Weiqin Li; Lu Ke; Jiajia Lin; Zhihui Tong; Weiqin Li; Yang Wang; Juan Xing; Zhongheng Zhang; Feng Guo; Tao Chen; Lixin Zhou; Dongpo Jiang; Qindong Shi; Jiandong Lin; Jun Liu; Aibin Cheng; Yafeng Liang; Peiyang Gao; Junli Sun; Wenming Liu; Zhenyu Yang; Rumin Zhang; Wei Xing; An Zhang; Zhigang Zhou; Tingfa Zhou; Yang Liu; Fei Tong; Qiuhui Wang; Aijun Pan; Xiaobo Huang; Chuming Fan; Weihua Lu; Dongwu Shi; Lei Wang; Wei Li; Liming Gu; Yingguang Xie; Rongqing Sun; Lin Han; Lihua Zhou; Xiangde Zheng; Feng Shan; Liandi Li; Jianbo Liu; Yuhang Ai; Yan Qu; Hailing Li; Zhiguo Pan; Donglin Xu; Zhiqiang Zou; Yan Gao; Chunli Yang; Qiuye Kou; Xijing Zhang; Jinglan Wu; Chuanyun Qian; Weixing Zhang; Minjie Zhang; Yongjian Feng; Yuan Zong; Bingyu Qin; Fusen Zhang; Zhe Zhai; Yun Sun; Ping Chang; Bo Yu; Min Yu; Shiying Yuan; Yijun Deng; Liyun Zhao; Bin Zang; Yuanfei Li; Fachun Zhou; Xiaomei Chen; Min Shao; Weidong Wu; Ming Wu; Zhaohui Zhang; Yimin Li; Qiang Guo; Zhiyong Wang; Yuanqi Gong; Yunlin Song; Kejian Qian; Baocai Fu; Xueyan Liu; Zhiping Li; Chuanyong Gong; Cheng Sun; Jian Yu; Zhongzhi Tang; Linxi Huang; Biao Ma; Zhijie He; Qingshan Zhou; Rongguo Yu

doi:10.1186/s13054-022-03921-5

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

Lu Ke, Jiajia Lin, Gordon S. Doig, Arthur R. H. van Zanten, Yang Wang, Juan Xing, Zhongheng Zhang, Tao Chen, Lixin Zhou, Dongpo Jiang, Qindong Shi, Jiandong Lin, Jun Liu, Aibin Cheng, Yafeng Liang, Peiyang Gao, Junli Sun, Wenming Liu, Zhenyu Yang, Rumin ZhangWei Xing, An Zhang, Zhigang Zhou, Tingfa Zhou, Yang Liu, Fei Tong, Qiuhui Wang, Aijun Pan, Xiaobo Huang, Chuming Fan, Weihua Lu, Dongwu Shi, Lei Wang, Wei Li, Liming Gu, Yingguang Xie, Rongqing Sun, Feng Guo, Lin Han, Lihua Zhou, Xiangde Zheng, Feng Shan, Jianbo Liu, Yuhang Ai, Yan Qu, Liandi Li, Hailing Li, Zhiguo Pan, Donglin Xu, Zhiqiang Zou, Yan Gao, Chunli Yang, Qiuye Kou, Xijing Zhang, Jinglan Wu, Chuanyun Qian, Weixing Zhang, Minjie Zhang, Yuan Zong, Bingyu Qin, Fusen Zhang, Zhe Zhai, Yun Sun, Ping Chang, Bo Yu, Min Yu, Shiying Yuan, Yijun Deng, Liyun Zhao, Bin Zang, Yuanfei Li, Fachun Zhou, Xiaomei Chen, Min Shao, Weidong Wu, Ming Wu, Zhaohui Zhang, Yimin Li, Qiang Guo, Zhiyong Wang, Yuanqi Gong, Yunlin Song, Kejian Qian, Yongjian Feng, Baocai Fu, Xueyan Liu, Zhiping Li, Chuanyong Gong, Cheng Sun, Jian Yu, Zhongzhi Tang, Linxi Huang, Biao Ma, Zhijie He, Qingshan Zhou, Rongguo Yu, Zhihui Tong, Weiqin Li, Lu Ke, Jiajia Lin, Zhihui Tong, Weiqin Li, Yang Wang, Juan Xing, Zhongheng Zhang, Feng Guo, Tao Chen, Lixin Zhou, Dongpo Jiang, Qindong Shi, Jiandong Lin, Jun Liu, Aibin Cheng, Yafeng Liang, Peiyang Gao, Junli Sun, Wenming Liu, Zhenyu Yang, Rumin Zhang, Wei Xing, An Zhang, Zhigang Zhou, Tingfa Zhou, Yang Liu, Fei Tong, Qiuhui Wang, Aijun Pan, Xiaobo Huang, Chuming Fan, Weihua Lu, Dongwu Shi, Lei Wang, Wei Li, Liming Gu, Yingguang Xie, Rongqing Sun, Lin Han, Lihua Zhou, Xiangde Zheng, Feng Shan, Liandi Li, Jianbo Liu, Yuhang Ai, Yan Qu, Hailing Li, Zhiguo Pan, Donglin Xu, Zhiqiang Zou, Yan Gao, Chunli Yang, Qiuye Kou, Xijing Zhang, Jinglan Wu, Chuanyun Qian, Weixing Zhang, Minjie Zhang, Yongjian Feng, Yuan Zong, Bingyu Qin, Fusen Zhang, Zhe Zhai, Yun Sun, Ping Chang, Bo Yu, Min Yu, Shiying Yuan, Yijun Deng, Liyun Zhao, Bin Zang, Yuanfei Li, Fachun Zhou, Xiaomei Chen, Min Shao, Weidong Wu, Ming Wu, Zhaohui Zhang, Yimin Li, Qiang Guo, Zhiyong Wang, Yuanqi Gong, Yunlin Song, Kejian Qian, Baocai Fu, Xueyan Liu, Zhiping Li, Chuanyong Gong, Cheng Sun, Jian Yu, Zhongzhi Tang, Linxi Huang, Biao Ma, Zhijie He, Qingshan Zhou, Rongguo Yu

Clinical Sciences

Research output: Contribution to journal › Article › peer-review

32 Citations (Scopus)

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.

Original language	English
Article number	46
Pages (from-to)	e46
Journal	Critical Care
Volume	26
Issue number	1
DOIs	https://doi.org/10.1186/s13054-022-03921-5
Publication status	Published - 16 Feb 2022

Keywords

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

Access to Document

10.1186/s13054-022-03921-5Licence: CC BY

13054 2022 Article 3921Final published version, 1.65 MBLicence: CC BY

32 Citations
1 Other contribution

Correction to: Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial.
Ke, L., Lin, J., Doig, G. S., van Zanten, A. R. H., Wang, Y., Xing, J., Zhang, Z., Chen, T., Zhou, L., Jiang, D., Shi, Q., Lin, J., Liu, J., Cheng, A., Liang, Y., Gao, P., Sun, J., Liu, W., Yang, Z. & Zhang, R. & 78 others, Xing, W., Zhang, A., Zhou, Z., Zhou, T., Liu, Y., Tong, F., Wang, Q., Pan, A., Huang, X., Fan, C., Lu, W., Shi, D., Wang, L., Li, W., Gu, L., Xie, Y., Sun, R., Guo, F., Han, L., Zhou, L., Zheng, X., Shan, F., Liu, J., Ai, Y., Qu, Y., Li, L., Li, H., Pan, Z., Xu, D., Zou, Z., Gao, Y., Yang, C., Kou, Q., Zhang, X., Wu, J., Qian, C., Zhang, W., Zhang, M., Zong, Y., Qin, B., Zhang, F., Zhai, Z., Sun, Y., Chang, P., Yu, B., Yu, M., Yuan, S., Deng, Y., Zhao, L., Zang, B., Li, Y., Zhou, F., Chen, X., Shao, M., Wu, W., Wu, M., Zhang, Z., Li, Y., Guo, Q., Wang, Z., Gong, Y., Song, Y., Qian, K., Feng, Y., Fu, B., Liu, X., Li, Z., Gong, C., Sun, C., Yu, J., Tang, Z., Huang, L., Ma, B., He, Z., Zhou, Q., Yu, R., Tong, Z. & Li, W., 21 Apr 2022, BioMed Central.
Research output: Other contribution

Open Access

2 Citations (Scopus)

Cite this

Ke, L., Lin, J., Doig, G. S., van Zanten, A. R. H., Wang, Y., Xing, J., Zhang, Z., Chen, T., Zhou, L., Jiang, D., Shi, Q., Lin, J., Liu, J., Cheng, A., Liang, Y., Gao, P., Sun, J., Liu, W., Yang, Z., ... Yu, R. (2022). Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial. Critical Care, 26(1), e46. Article 46. https://doi.org/10.1186/s13054-022-03921-5

@article{c40ac4fbe05843cb8b87fac2b3798617,

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

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.",

keywords = "Cluster-randomized trial, Evidence-based guideline, Intensive care unit, Nutrition therapy",

author = "Lu Ke and Jiajia Lin and Doig, \{Gordon S.\} and \{van Zanten\}, \{Arthur R. H.\} and Yang Wang and Juan Xing and Zhongheng Zhang and Tao Chen and Lixin Zhou and Dongpo Jiang and Qindong Shi and Jiandong Lin and Jun Liu and Aibin Cheng and Yafeng Liang and Peiyang Gao and Junli Sun and Wenming Liu and Zhenyu Yang and Rumin Zhang and Wei Xing and An Zhang and Zhigang Zhou and Tingfa Zhou and Yang Liu and Fei Tong and Qiuhui Wang and Aijun Pan and Xiaobo Huang and Chuming Fan and Weihua Lu and Dongwu Shi and Lei Wang and Wei Li and Liming Gu and Yingguang Xie and Rongqing Sun and Feng Guo and Lin Han and Lihua Zhou and Xiangde Zheng and Feng Shan and Jianbo Liu and Yuhang Ai and Yan Qu and Liandi Li and Hailing Li and Zhiguo Pan and Donglin Xu and Zhiqiang Zou and Yan Gao and Chunli Yang and Qiuye Kou and Xijing Zhang and Jinglan Wu and Chuanyun Qian and Weixing Zhang and Minjie Zhang and Yuan Zong and Bingyu Qin and Fusen Zhang and Zhe Zhai and Yun Sun and Ping Chang and Bo Yu and Min Yu and Shiying Yuan and Yijun Deng and Liyun Zhao and Bin Zang and Yuanfei Li and Fachun Zhou and Xiaomei Chen and Min Shao and Weidong Wu and Ming Wu and Zhaohui Zhang and Yimin Li and Qiang Guo and Zhiyong Wang and Yuanqi Gong and Yunlin Song and Kejian Qian and Yongjian Feng and Baocai Fu and Xueyan Liu and Zhiping Li and Chuanyong Gong and Cheng Sun and Jian Yu and Zhongzhi Tang and Linxi Huang and Biao Ma and Zhijie He and Qingshan Zhou and Rongguo Yu and Zhihui Tong and Weiqin Li and Lu Ke and Jiajia Lin and Zhihui Tong and Weiqin Li and Yang Wang and Juan Xing and Zhongheng Zhang and Feng Guo and Tao Chen and Lixin Zhou and Dongpo Jiang and Qindong Shi and Jiandong Lin and Jun Liu and Aibin Cheng and Yafeng Liang and Peiyang Gao and Junli Sun and Wenming Liu and Zhenyu Yang and Rumin Zhang and Wei Xing and An Zhang and Zhigang Zhou and Tingfa Zhou and Yang Liu and Fei Tong and Qiuhui Wang and Aijun Pan and Xiaobo Huang and Chuming Fan and Weihua Lu and Dongwu Shi and Lei Wang and Wei Li and Liming Gu and Yingguang Xie and Rongqing Sun and Lin Han and Lihua Zhou and Xiangde Zheng and Feng Shan and Liandi Li and Jianbo Liu and Yuhang Ai and Yan Qu and Hailing Li and Zhiguo Pan and Donglin Xu and Zhiqiang Zou and Yan Gao and Chunli Yang and Qiuye Kou and Xijing Zhang and Jinglan Wu and Chuanyun Qian and Weixing Zhang and Minjie Zhang and Yongjian Feng and Yuan Zong and Bingyu Qin and Fusen Zhang and Zhe Zhai and Yun Sun and Ping Chang and Bo Yu and Min Yu and Shiying Yuan and Yijun Deng and Liyun Zhao and Bin Zang and Yuanfei Li and Fachun Zhou and Xiaomei Chen and Min Shao and Weidong Wu and Ming Wu and Zhaohui Zhang and Yimin Li and Qiang Guo and Zhiyong Wang and Yuanqi Gong and Yunlin Song and Kejian Qian and Baocai Fu and Xueyan Liu and Zhiping Li and Chuanyong Gong and Cheng Sun and Jian Yu and Zhongzhi Tang and Linxi Huang and Biao Ma and Zhijie He and Qingshan Zhou and Rongguo Yu",

year = "2022",

month = feb,

day = "16",

doi = "10.1186/s13054-022-03921-5",

language = "English",

volume = "26",

pages = "e46",

journal = "Critical Care",

issn = "1364-8535",

publisher = "BioMed Central Ltd",

number = "1",

}

Ke, L, Lin, J, Doig, GS, van Zanten, ARH, Wang, Y, Xing, J, Zhang, Z, Chen, T, Zhou, L, Jiang, D, Shi, Q, Lin, J, Liu, J, Cheng, A, Liang, Y, Gao, P, Sun, J, Liu, W, Yang, Z, Zhang, R, Xing, W, Zhang, A, Zhou, Z, Zhou, T, Liu, Y, Tong, F, Wang, Q, Pan, A, Huang, X, Fan, C, Lu, W, Shi, D, Wang, L, Li, W, Gu, L, Xie, Y, Sun, R, Guo, F, Han, L, Zhou, L, Zheng, X, Shan, F, Liu, J, Ai, Y, Qu, Y, Li, L, Li, H, Pan, Z, Xu, D, Zou, Z, Gao, Y, Yang, C, Kou, Q, Zhang, X, Wu, J, Qian, C, Zhang, W, Zhang, M, Zong, Y, Qin, B, Zhang, F, Zhai, Z, Sun, Y, Chang, P, Yu, B, Yu, M, Yuan, S, Deng, Y, Zhao, L, Zang, B, Li, Y, Zhou, F, Chen, X, Shao, M, Wu, W, Wu, M, Zhang, Z, Li, Y, Guo, Q, Wang, Z, Gong, Y, Song, Y, Qian, K, Feng, Y, Fu, B, Liu, X, Li, Z, Gong, C, Sun, C, Yu, J, Tang, Z, Huang, L, Ma, B, He, Z, Zhou, Q, Yu, R, Tong, Z, Li, W, Ke, L, Lin, J, Tong, Z, Li, W, Wang, Y, Xing, J, Zhang, Z, Guo, F, Chen, T, Zhou, L, Jiang, D, Shi, Q, Lin, J, Liu, J, Cheng, A, Liang, Y, Gao, P, Sun, J, Liu, W, Yang, Z, Zhang, R, Xing, W, Zhang, A, Zhou, Z, Zhou, T, Liu, Y, Tong, F, Wang, Q, Pan, A, Huang, X, Fan, C, Lu, W, Shi, D, Wang, L, Li, W, Gu, L, Xie, Y, Sun, R, Han, L, Zhou, L, Zheng, X, Shan, F, Li, L, Liu, J, Ai, Y, Qu, Y, Li, H, Pan, Z, Xu, D, Zou, Z, Gao, Y, Yang, C, Kou, Q, Zhang, X, Wu, J, Qian, C, Zhang, W, Zhang, M, Feng, Y, Zong, Y, Qin, B, Zhang, F, Zhai, Z, Sun, Y, Chang, P, Yu, B, Yu, M, Yuan, S, Deng, Y, Zhao, L, Zang, B, Li, Y, Zhou, F, Chen, X, Shao, M, Wu, W, Wu, M, Zhang, Z, Li, Y, Guo, Q, Wang, Z, Gong, Y, Song, Y, Qian, K, Fu, B, Liu, X, Li, Z, Gong, C, Sun, C, Yu, J, Tang, Z, Huang, L, Ma, B, He, Z, Zhou, Q & Yu, R 2022, 'Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial', Critical Care, vol. 26, no. 1, 46, pp. e46. https://doi.org/10.1186/s13054-022-03921-5

TY - JOUR

T1 - Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial

AU - Ke, Lu

AU - Lin, Jiajia

AU - Doig, Gordon S.

AU - van Zanten, Arthur R. H.

AU - Wang, Yang

AU - Xing, Juan

AU - Zhang, Zhongheng

AU - Chen, Tao

AU - Zhou, Lixin

AU - Jiang, Dongpo

AU - Shi, Qindong

AU - Lin, Jiandong

AU - Liu, Jun

AU - Cheng, Aibin

AU - Liang, Yafeng

AU - Gao, Peiyang

AU - Sun, Junli

AU - Liu, Wenming

AU - Yang, Zhenyu

AU - Zhang, Rumin

AU - Xing, Wei

AU - Zhang, An

AU - Zhou, Zhigang

AU - Zhou, Tingfa

AU - Liu, Yang

AU - Tong, Fei

AU - Wang, Qiuhui

AU - Pan, Aijun

AU - Huang, Xiaobo

AU - Fan, Chuming

AU - Lu, Weihua

AU - Shi, Dongwu

AU - Wang, Lei

AU - Li, Wei

AU - Gu, Liming

AU - Xie, Yingguang

AU - Sun, Rongqing

AU - Guo, Feng

AU - Han, Lin

AU - Zhou, Lihua

AU - Zheng, Xiangde

AU - Shan, Feng

AU - Liu, Jianbo

AU - Ai, Yuhang

AU - Qu, Yan

AU - Li, Liandi

AU - Li, Hailing

AU - Pan, Zhiguo

AU - Xu, Donglin

AU - Zou, Zhiqiang

AU - Gao, Yan

AU - Yang, Chunli

AU - Kou, Qiuye

AU - Zhang, Xijing

AU - Wu, Jinglan

AU - Qian, Chuanyun

AU - Zhang, Weixing

AU - Zhang, Minjie

AU - Zong, Yuan

AU - Qin, Bingyu

AU - Zhang, Fusen

AU - Zhai, Zhe

AU - Sun, Yun

AU - Chang, Ping

AU - Yu, Bo

AU - Yu, Min

AU - Yuan, Shiying

AU - Deng, Yijun

AU - Zhao, Liyun

AU - Zang, Bin

AU - Li, Yuanfei

AU - Zhou, Fachun

AU - Chen, Xiaomei

AU - Shao, Min

AU - Wu, Weidong

AU - Wu, Ming

AU - Zhang, Zhaohui

AU - Li, Yimin

AU - Guo, Qiang

AU - Wang, Zhiyong

AU - Gong, Yuanqi

AU - Song, Yunlin

AU - Qian, Kejian

AU - Feng, Yongjian

AU - Fu, Baocai

AU - Liu, Xueyan

AU - Li, Zhiping

AU - Gong, Chuanyong

AU - Sun, Cheng

AU - Yu, Jian

AU - Tang, Zhongzhi

AU - Huang, Linxi

AU - Ma, Biao

AU - He, Zhijie

AU - Zhou, Qingshan

AU - Yu, Rongguo

AU - Tong, Zhihui

AU - Li, Weiqin

AU - Ke, Lu

AU - Lin, Jiajia

AU - Tong, Zhihui

AU - Li, Weiqin

AU - Wang, Yang

AU - Xing, Juan

AU - Zhang, Zhongheng

AU - Guo, Feng

AU - Chen, Tao

AU - Zhou, Lixin

AU - Jiang, Dongpo

AU - Shi, Qindong

AU - Lin, Jiandong

AU - Liu, Jun

AU - Cheng, Aibin

AU - Liang, Yafeng

AU - Gao, Peiyang

AU - Sun, Junli

AU - Liu, Wenming

AU - Yang, Zhenyu

AU - Zhang, Rumin

AU - Xing, Wei

AU - Zhang, An

AU - Zhou, Zhigang

AU - Zhou, Tingfa

AU - Liu, Yang

AU - Tong, Fei

AU - Wang, Qiuhui

AU - Pan, Aijun

AU - Huang, Xiaobo

AU - Fan, Chuming

AU - Lu, Weihua

AU - Shi, Dongwu

AU - Wang, Lei

AU - Li, Wei

AU - Gu, Liming

AU - Xie, Yingguang

AU - Sun, Rongqing

AU - Han, Lin

AU - Zhou, Lihua

AU - Zheng, Xiangde

AU - Shan, Feng

AU - Li, Liandi

AU - Liu, Jianbo

AU - Ai, Yuhang

AU - Qu, Yan

AU - Li, Hailing

AU - Pan, Zhiguo

AU - Xu, Donglin

AU - Zou, Zhiqiang

AU - Gao, Yan

AU - Yang, Chunli

AU - Kou, Qiuye

AU - Zhang, Xijing

AU - Wu, Jinglan

AU - Qian, Chuanyun

AU - Zhang, Weixing

AU - Zhang, Minjie

AU - Feng, Yongjian

AU - Zong, Yuan

AU - Qin, Bingyu

AU - Zhang, Fusen

AU - Zhai, Zhe

AU - Sun, Yun

AU - Chang, Ping

AU - Yu, Bo

AU - Yu, Min

AU - Yuan, Shiying

AU - Deng, Yijun

AU - Zhao, Liyun

AU - Zang, Bin

AU - Li, Yuanfei

AU - Zhou, Fachun

AU - Chen, Xiaomei

AU - Shao, Min

AU - Wu, Weidong

AU - Wu, Ming

AU - Zhang, Zhaohui

AU - Li, Yimin

AU - Guo, Qiang

AU - Wang, Zhiyong

AU - Gong, Yuanqi

AU - Song, Yunlin

AU - Qian, Kejian

AU - Fu, Baocai

AU - Liu, Xueyan

AU - Li, Zhiping

AU - Gong, Chuanyong

AU - Sun, Cheng

AU - Yu, Jian

AU - Tang, Zhongzhi

AU - Huang, Linxi

AU - Ma, Biao

AU - He, Zhijie

AU - Zhou, Qingshan

AU - Yu, Rongguo

PY - 2022/2/16

Y1 - 2022/2/16

N2 - 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.

AB - 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.

KW - Cluster-randomized trial

KW - Evidence-based guideline

KW - Intensive care unit

KW - Nutrition therapy

U2 - 10.1186/s13054-022-03921-5

DO - 10.1186/s13054-022-03921-5

M3 - Article

SN - 1364-8535

VL - 26

SP - e46

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 46

ER -

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

Abstract

Keywords

Access to Document

Fingerprint

Research output

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

Cite this