Evidence Application Of Enteral Nutrition Support In Adult Patients With Severe Traumatic Brain Injury

Objective:1.To summarize the best evidence for enteral nutrition support in adult patients with severe craniocerebral injury and to construct a review index.2.Conduct baseline reviews based on review indicators,assess and analyze barriers to clinical practice at the system and individual levels(both patient and practitioner)based on clinical review results,and construct appropriate action strategies.3.Applying action strategies to the clinic and evaluating their effectiveness.Methods:Based on the "6S" evidence-based resource pyramid,we systematically searched the literature on enteral nutrition support for adults with severe craniocerebral injury from top to bottom,evaluated the quality of the literature,and summarized the best evidence.A meeting was held to evaluate the evidence for inclusion,determine the final evidence for clinical application,and form the review index.To review the current status of clinical practice of enteral nutrition support for adult patients with heavy craniocerebral injury in a tertiary care hospital in Hefei,analyze the barrier factors,and construct corresponding action strategies for clinical application of the evidence.To compare changes in patient outcomes and complication rates of nutritional support,nurses’ knowledge beliefs behavioural levels and management of nutritional support delivery before and after application of the evidence.Results:1.A total of 18 papers were included in this study,summarizing a total of 25 best evidence in 8 areas of nutritional screening,nutritional assessment,timing of initiation of enteral nutrition,energy and protein requirements,nutrient composition,feeding route,infusion method and management of complications.2.After the expert panel discussion,11 best evidence were finally included and 18 clinical review indicators were constructed.The review results showed that 12 indicators achieved <60%,including 6 indicators with 0 achievement rate.3.Barriers to the application of evidence include lack of standardized processes,lack of relevant knowledge among healthcare professionals,insufficient training,and inadequate supplies,and targeted action strategies are proposed.4.The four nutritional indicators of total protein,albumin,hemoglobin,and prealbumin were significantly higher in the intervention group than in the control group at 7 d of admission(P < 0.01),and the amount of energy and protein feeding compliance was also significantly higher in the intervention group than in the control group at d 5(P < 0.05),and the incidence of feeding intolerance was significantly lower in the intervention group than in the control group(P < 0.05).Nutrition knowledge,attitudes and behaviors of nursing staff were significantly higher after evidence application than before evidence application(P < 0.05),and all clinical review indicators were improved compared with the baseline review.Conclusion:The results of this study show that evidence-based practice protocols are conducive to improving the nutritional status of patients with heavy craniocerebral injury,reducing the incidence of complications,and improving the level of nursing staff’s knowledge and beliefs about enteral nutrition to a certain extent,as well as standardizing the management system of enteral nutrition for such patients,improving the implementation process,and enhancing the quality of care,and providing a reference for clinical nursing staff to carry out evidence-based practice in the future.