Using Volume-Based Tube Feeding to Increase Nutrient Delivery in Patients on a Rehabilitation Unit

Abstract

Purpose The purpose of this study was to determine whether volume-based tube feeding (VBTF) increased nutrient delivery to patients in a rehabilitation unit. Design A cohort study with a prospective group and a historical control group was used as the study design. Methods The intervention was VBTF, a change from the standard hourly rate-based enteral nutrition. Data were collected on 70 rehabilitation patients. Data on the control group (n = 35) were collected through retrospective chart review of rate-based tube-fed patients. Data on the VBTF intervention group (n = 35) were collected prospectively after implementation of VBTF in the inpatient medical rehabilitation unit at University of Utah Health. Findings The results showed patients in the VBTF group received 82% of their prescribed feed whereas rate-based patients received 70%. Clinical Relevance VBTF appears to increase the amount of nutrition inpatient medical rehabilitation patients receive, which may help with the intensive therapy sessions these patients must undergo.

Volume‐based enteral feeding for ward patients with acute neurological conditions: a pilot prospective cohort study

“…18,29,33,35,36 Ward-based literature includes a recent cohort study investigating VBF in a medical rehabilitation unit. 37 Compared to our study, these authors found similar RBF EN adequacy (67%) but a lower improvement in their VBF intervention group (92% vs. 82%). 37 This may be due to their lower maximum feeding rate (150 ml/h), limited ongoing staff education or undefined catch-up feeding times.…”

“…37 Compared to our study, these authors found similar RBF EN adequacy (67%) but a lower improvement in their VBF intervention group (92% vs. 82%). 37 This may be due to their lower maximum feeding rate (150 ml/h), limited ongoing staff education or undefined catch-up feeding times. 37 In contrast, our study integrated a protocol with predefined time points for catch-up feeding (12:00 PM and 6:00 PM) and a comprehensive education with nurse-led champions.…”

Clinician's Guide to Understanding Effect Size, Alpha Level, Power, and Sample Size

“…For example, results of studies comparing volumebased with rate-based feeding protocols report a significant improvement in percentage of calorie requirements delivered. [7][8][9][10][11] Sachdev et al observed a significant difference in percentage of calorie delivery between the volumebased (73%) and rate-based feeding groups (65%); the effect size for this difference in calorie delivery is 0.6, typically indicating a medium effect. 8 However, in this example, the difference in percentage of calorie delivery methods was only 8%, which may not be considered a moderate, or medium, change.…”

“…Studies with a small effect size may have clinically meaningful outcomes, whereas studies with a large effect size may not provide a relevant result. For example, results of studies comparing volume‐based with rate‐based feeding protocols report a significant improvement in percentage of calorie requirements delivered 7–11 . Sachdev et al observed a significant difference in percentage of calorie delivery between the volume‐based (73%) and rate‐based feeding groups (65%); the effect size for this difference in calorie delivery is 0.6, typically indicating a medium effect 8 .…”

“…Studies A and B are designed to examine the difference in calorie delivery between patients randomized to receive a volume-vs rate-based infusion of enteral nutrition. Based on the available studies, [7][8][9][10][11] the observed effect size ranges from 0.6 to 1.1. As seen in Table 3, study A used an effect size of 1.1, and study B used an effect size of 0.6.…”