A Post-Extubation Early Feeding Protocol (PEEF) in a Tertiary Paediatric Intensive Care Unit: A Quality Improvement Initiative

Abstract

AIM: Recommencing enteral feeding post-extubation in children is often delayed. This study evaluated a Post-Extubation Early Feeding (PEEF) protocol on early recommencement of enteral nutrition post-extubation in a tertiary paediatric intensive care unit (PICU). METHODS: The PEEF protocol involved direction to re-commence enteral nutrition at 50% of the pre-fasting rate within 1 h of extubation and upgrade to the pre-extubation feeding rate within 2 h. The PEEF protocol was a quality improvement project implemented at a tertiary PICU and was evaluated through a retrospective analysis. The study included children aged 0-18 years who were admitted to PICU, intubated and subsequently underwent planned extubation pre-PEEF (November 2019-October 2020) and post-PEEF (November 2021-October 2022). RESULTS: A total of 795 patients were included in the study, 372 pre-PEEF and 423 post-PEEF. Demographic variables and severity of illness variables were similar in the two groups. Post implementation of the PEEF protocol, the median (interquartile range) time to re-commence enteral nutrition after extubation was 3.2 h (1.9, 4.7) compared to pre-PEEF, 4.2 h (3.2, 5.5; p = 2.4 × 10(-13)). Post-PEEF the median time to reach the pre-fasting feeding rate was 5 h (2.6, 10.6), compared to 7.3 h (4.1, 13) pre-PEEF (p = 0.0005). CONCLUSIONS: Implementation of the PEEF protocol reduced the time to resume enteral nutrition and the time to reach pre-extubation feeding rates although improvement was not consistent with the goals of PEEF. Continuing assessment and education are required to drive outcomes further towards target goals.