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Nutr Clin Pract. 2008 Dec-2009 Jan;23(6):642-50. doi: 10.1177/0884533608326062.

Are enterally fed ICU patients meeting clinical practice guidelines?

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Toronto General Hospital, University Health Network.



The 2003 Canadian clinical practice guidelines (CPGs) for nutrition support in mechanically ventilated, critically ill patients recommended early EN and maintaining a 45-degree head-of-bed (HOB) angle during EN administration. Current practices at University Health Network have not been examined with regard to these guidelines. The purpose of this study was to determine the proportion of mechanically ventilated, enterally fed intensive care unit patients meeting the CPG recommendations for early EN and HOB elevation.


This was a cross-sectional study involving data collection in 2 parts. Early EN data were collected via chart review and HOB data through observation of HOB angle reader. Reasons for not meeting each recommendation were obtained when data were collected via chart review and feedback from nurses. data analysis was conducted using frequency distributions.


sixty-six percent of patients met the recommendation for early en. of those not meeting this recommendation, the most common reason for the delay was hemodynamic instability (28.1%). for the hob recommendation, 4.9% of patients met the 45 degree recommendation, and 52.5% had an hob angle between 21 and 30 degrees. the most common reason for not attaining the 45-degree angle was reported as unknown (29.5%).


The proportion of patients meeting clinical practice guidelines compares favorably to similar studies. In some cases, patients' clinical conditions or unit HOB angle protocol explained not meeting guidelines. However, there were cases where reasons for not meeting guidelines were unknown.

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