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

作者：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, Xing Wei, An Zhang, Zhigang Zhou, Tingfa Zhou, Yang Liu, Fei Tong, Qiuhui Wang, Aijun Pan, Xiaobo Huang, Chuming Fan, Weihua Lü, Dongwu Shi, Lei Wang, Wei Li, 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, Shiying Yuan, 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, Yunlin Song, Yunlin Song, Kejian Qian, Yongjian Feng, Baocai Fu, Zhiping Li, Zhiping Li, Chuanyong Gong, Cheng Sun, Jian Yu, Zhongzhi Tang, Linxi Huang, Biao Ma, Zhijie He, Qingshan Zhou, Rongguo Yu, Zhihui Tong, Weiqin Li, Weiqin Li, for the Chinese Critcal Care Nutrition Trials Group (CCCNTG), Lu Ke, Jiajia Lin, Zhihui Tong, Weiqin Li, 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 Lü, Dongwu Shi, Lei Wang, Wei Li, 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, Fusen 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 · 发表于：Critical Care · 年份：2022 · DOI：10.1186/s13054-022-03921-5 · 被引用次数：53 · 研究领域：Clinical Nutrition and Gastroenterology、Nutrition and Health in Aging、Dysphagia Assessment and Management

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...