본문 바로가기
KERD
논문KCI 등재

소아심장외과 중환자실 장관영양 프로토콜 개발 및 효과평가

Development and Implementation of a Feeding Protocol for Pediatric Cardiac Intensive Care Units

0

조회

0

다운로드

2

인용

0

참고문헌

키워드

주제분류간호학

초록

Purpose: It is crucial to provide adequate enteral nutrition for postoperative recovery, wound healing and normal growth in infants in pediatric cardiac ICUs. This study was done to develop a feeding protocol using the vaso-active inotropic (VAI) score and to evaluate the impact of nutritional outcomes following the new feeding protocol for infants who underwent cardiac surgery. Methods: This study consisted of three phases. First, a feeding protocol was developed based on a literature review. Second, ten experts rated the content validity. Third, a comparison study was conducted to evaluate the impact of the new feeding protocol. Data were analyzed using SPSS Version 20. Results: Twenty-nine infants were enrolled in the pre-protocol group, and 22 infants in the post-protocol group. Patients in the 2 groups were similar. Time to reach feeding goal was significantly decreased from 56.0 (27-210) hours to 28.5 (10-496) hours in the post-protocol group (Z=-4.22, p<.001). Level of enteral feeding knowledge among nurses increased significantly after implementation of the protocol.. Conclusion: The feeding protocol using VAI score facilitates the achievement feeding goal to decrease feeding interruptions and help nurses in their practice. Larger studies are necessary to examine clinical outcomes following the implementation of this feeding protocol.

Abstract

Purpose: It is crucial to provide adequate enteral nutrition for postoperative recovery, wound healing and normal growth in infants in pediatric cardiac ICUs. This study was done to develop a feeding protocol using the vaso-active inotropic (VAI) score and to evaluate the impact of nutritional outcomes following the new feeding protocol for infants who underwent cardiac surgery. Methods: This study consisted of three phases. First, a feeding protocol was developed based on a literature review. Second, ten experts rated the content validity. Third, a comparison study was conducted to evaluate the impact of the new feeding protocol. Data were analyzed using SPSS Version 20. Results: Twenty-nine infants were enrolled in the pre-protocol group, and 22 infants in the post-protocol group. Patients in the 2 groups were similar. Time to reach feeding goal was significantly decreased from 56.0 (27-210) hours to 28.5 (10-496) hours in the post-protocol group (Z=-4.22, p<.001). Level of enteral feeding knowledge among nurses increased significantly after implementation of the protocol.. Conclusion: The feeding protocol using VAI score facilitates the achievement feeding goal to decrease feeding interruptions and help nurses in their practice. Larger studies are necessary to examine clinical outcomes following the implementation of this feeding protocol.

참고문헌 (30)

  1. Jeffrey B. Anderson, "Poor post-operative growth in infants with two-ventricle physiology", Cardiology in the Young, 21(04), pp.421~429 (2011), Cambridge University Press (CUP)[DOI]
  2. Wang KS, "Metabolic Response to Stress in the Neonate Who Has Surgery", NeoReviews, 7(8), pp.410~418 (2006)
  3. Alpers DH, "Enteral feeding and gut atrophy", Current Opinion in Clinical Nutrition and Metabolic Care, 5(6), pp.679~683 (2002)[DOI]
  4. Brian E. Kogon, "Feeding Difficulty in Newborns Following Congenital Heart Surgery", Congenital Heart Disease, 2(5), pp.332~337 (2007), Wiley-Blackwell[DOI]
  5. Varan B, "Malnutrition and growth failure in cyanotic and acyanotic congenital heart disease with and without pulmo nary hypertension", Archives of Disease in Childhood, 81(1), pp.49~52 (1999)
  6. C. R. Schwalbe-Terilli, "Enteral Feeding and Caloric Intake in Neonates After Cardiac Surgery", American Journal of Critical Care, 18(1), pp.52~57 (2009), AACN Publishing[DOI]
  7. R. Meyer, "The impact of enteral feeding protocols on nutritional support in critically ill children", Journal of Human Nutrition and Dietetics, 22(5), pp.428~436 (2009), Wiley-Blackwell[DOI]
  8. Howard E. Jeffries, "Gastrointestinal Morbidity After Norwood Palliation for Hypoplastic Left Heart Syndrome", The Annals of Thoracic Surgery, 81(3), pp.982~987 (2006), Elsevier BV[DOI]
  9. Deanne K. Kelleher, "Growth and correlates of nutritional status among infants with hypoplastic left heart syndrome (HLHS) after stage 1 Norwood procedure", Nutrition, 22(3), pp.237~244 (2006), Elsevier BV[DOI]
  10. Cheryl A Woolsey, "Vasoactive drugs and the gut: is there anything new?", Current Opinion in Critical Care, 12(2), pp.155~159 (2006), Ovid Technologies (Wolters Kluwer Health)[DOI]
  11. N. M. Mehta, "Approach to Enteral Feeding in the PICU", Nutrition in Clinical Practice, 24(3), pp.377~387 (2009), SAGE Publications[DOI]
  12. Jessica R. Golbus, "Feeding Complications in Hypoplastic Left Heart Syndrome After the Norwood Procedure: A Systematic Review of the Literature", Pediatric Cardiology, 32(4), pp.539~552 (2011), Springer Nature[DOI]
  13. Bowman A, "Implementation of an evidence-based feeding protocol and aspiration risk reduction algorithm", Critical Care Nursing Quarterly, 28(4), pp.324~335 (2005)
  14. Anneli REEVES, "Multidisciplinary evaluation of a critical care enteral feeding algorithm", Nutrition & Dietetics, 69(4), pp.242~249 (2012), Wiley-Blackwell[DOI]
  15. Julie Slicker, "Nutrition Algorithms for Infants with Hypoplastic Left Heart Syndrome; Birth through the First Interstage Period", Congenital Heart Disease, 8(2), pp.89~102 (2013), Wiley-Blackwell[DOI]
  16. Sylvia L. del Castillo, "Reducing the incidence of necrotizing enterocolitis in neonates with hypoplastic left heart syndrome with the introduction of an enteral feed protocol*", Pediatric Critical Care Medicine, 11(3), pp.373~377 (2010), Ovid Technologies (Wolters Kluwer Health)[DOI]
  17. Nancy J. Braudis, "Enteral feeding algorithm for infants with hypoplastic left heart syndrome poststage I palliation", Pediatric Critical Care Medicine, 10(4), pp.460~466 (2009), Ovid Technologies (Wolters Kluwer Health)[DOI]
  18. D. Davis, "Feeding Difficulties and Growth Delay in Children with Hypoplastic Left Heart Syndrome versus d-Transposition of the Great Arteries", Pediatric Cardiology, 29(2), pp.328~333 (2008), Springer Nature[DOI]
  19. Gaies MG GJ, "Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass", Pediatric Critical Care Medicine, 11(2), pp.234~238 (2010)
  20. Petrillo-Albarano T, "Use of a feeding protocol to improve nutritional support through early, aggressive, enteral nutrition in the pediatric intensive care unit", Pediatric Critical Care Medicine, 7(4), pp.340~344 (2006)
  21. Tiffany A. Moore, "Feeding Intolerance", Advances in Neonatal Care, 11(3), pp.149~154 (2011), Ovid Technologies (Wolters Kluwer Health)[DOI]
  22. "NHS Institute for Innovation and Improvement. Protocol based care" (2010)[URL]
  23. Park MS, "A study on development of a protocol for operating room infection control nursing", master, pp.2011
  24. Yoshimura S, "Efficacy of an enteral feeding protocol for providing nutritional support after paediatric cardiac surgery", Anaesthesia and Intensive Care, 43(5), pp.587~593 (2015)
  25. Erin Jenkins, "Feeding Protocols for Neonates With Hypoplastic Left Heart Syndrome", AACN Advanced Critical Care, 26(3), pp.215~221 (2015), AACN Publishing[DOI]
  26. King W, "Enteral nutrition and cardiovascular medications in the pediatric intensive care unit", Journal of Parenteral and Enteral Nutrition, 28(5), pp.334~338 (2004)
  27. K. Leutert, "Development and implementation of a feeding algorithm to optimise nutrition in Paediatric Intensive Care", Australian Critical Care, 28(1), pp.45~ (2015), Elsevier BV[DOI]
  28. Ravi R. Thiagarajan, "Improving safety for children with cardiac disease", Cardiology in the Young, 17(S2) (2007), Cambridge University Press (CUP)[DOI]
  29. Rodriguez L, "Nutritional status : assessing and understanding its value in the critical care setting", Critical Care Nursing Clinics of North America, 16(4), pp.509~514 (2004)
  30. Jonas RA, "Comprehensive surgical management of congenital heart disese", pp.90~91 (2014), CRC Press

관련 논문AI추천

이 간행물의 다른 논문 (15건)