Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial Article Swipe
YOU?
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· 2022
· Open Access
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· DOI: https://doi.org/10.1186/s13054-022-03921-5
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.
Related Topics
- Type
- article
- Language
- en
- Landing Page
- https://doi.org/10.1186/s13054-022-03921-5
- https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-022-03921-5
- OA Status
- gold
- Cited By
- 40
- References
- 23
- Related Works
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- OpenAlex ID
- https://openalex.org/W4212928251
Raw OpenAlex JSON
- OpenAlex ID
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https://openalex.org/W4212928251Canonical identifier for this work in OpenAlex
- DOI
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https://doi.org/10.1186/s13054-022-03921-5Digital Object Identifier
- Title
-
Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trialWork title
- Type
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articleOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2022Year of publication
- Publication date
-
2022-02-16Full publication date if available
- Authors
-
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, 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, Liming Gu, Xie Ying-guang, 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, Zhijie He, Qingshan Zhou, Rongguo Yu, Zhihui Tong, Weiqin Li, Lu Ke, Jiajia Lin, Zhihui Tong, Weiqin LiList of authors in order
- Landing page
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https://doi.org/10.1186/s13054-022-03921-5Publisher landing page
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https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-022-03921-5Direct link to full text PDF
- Open access
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YesWhether a free full text is available
- OA status
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goldOpen access status per OpenAlex
- OA URL
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https://ccforum.biomedcentral.com/track/pdf/10.1186/s13054-022-03921-5Direct OA link when available
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Medicine, Guideline, Randomized controlled trial, Intensive care, Cluster randomised controlled trial, Cluster (spacecraft), Emergency medicine, Intensive care medicine, Internal medicine, Pathology, Computer science, Programming languageTop concepts (fields/topics) attached by OpenAlex
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40Total citation count in OpenAlex
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2025: 9, 2024: 16, 2023: 7, 2022: 8Per-year citation counts (last 5 years)
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23Number of works referenced by this work
- Related works (count)
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10Other works algorithmically related by OpenAlex
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| abstract_inverted_index.members | 97 |
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| abstract_inverted_index.overall | 277 |
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| abstract_inverted_index.primary | 132 |
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| abstract_inverted_index.resulted | 180 |
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| institutions_distinct_count | 192 |
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