A Post‐Extubation Early Feeding Protocol ( PEEF ) in a Tertiary Paediatric Intensive Care Unit: A Quality Improvement Initiative
Year: 2025
Type: article
Abstract: 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.
DOI: 10.1111/jpc.70251
Authors: Sora Jung, Sainath Raman, Ian Hughes, Rahul Joshi
Language: English
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W4416936663