A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults

Jenkins, Bethan; Calder, Philip C.; Marino, Luise V.

doi:10.1016/j.clnesp.2022.04.014

Cited by 24 publications

(34 citation statements)

References 115 publications

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“…In others it was defined as a specific gastric residual volume, ranging from 100 to 500 mL, measured using several different methods, for example, manual aspiration, gastric emptying scintigraphy, manometry and 13 C‐octanoic acid breath tests. The varying definitions and measuring methods makes it difficult to compare studies and may explain why the prevalence of feeding intolerance within the same population varies between 4.6% and 86.1% 120 . Additionally, the clinical relevance of gastric residual volume is questionable.…”

Section: Discussionmentioning

confidence: 99%

Use of prokinetic agents in hospitalised adult patients: A scoping review

Crone

Møller

Bækgaard

et al. 2023

Acta Anaesthesiol Scand

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Background: Gastrointestinal motility is important for adequate uptake of fluids and nutrition but is often impaired in hospitalised patients. Prokinetic agents enhance gastrointestinal motility and are prescribed for many hospitalised patients. In this scoping review, we aimed to systematically describe the body of evidence on the use of prokinetic agents in hospitalised patients. We hypothesised, that the body of evidence would be limited and derive from heterogeneous populations. Methods: We conducted this scoping review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement. We searched Medline, Embase, Epistemonikos and the Cochrane Library for studies assessing the use of prokinetic agents on any indication and outcome in adult hospitalised patients. We used a modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to assess the certainty of evidence. Results:We included 102 studies with a total of 8830 patients. Eighty-six studies were clinical trials (84%), and 52 (60%) of these were conducted in the intensive care unit, with feeding intolerance as the main indication. In the non-intensive care setting the indications were wider; most studies assessed use of prokinetic agents before gastroscopy to improve visualisation. The most studied prokinetic agent was metoclopramide (49% of studies) followed by erythromycin (31%). In total 147 outcomes were assessed with only 67% of the included studies assessing patient-centred outcomes, and with gastric emptying as the most frequently reported outcome. Overall, the data provided no firm evidence on the balance between the desirable and undesirable effects of prokinetic agents. Conclusions:In this scoping review, we found that the studies addressing prokinetic agents in hospitalised adults had considerable variations in indications, drugs and outcomes assessed, and that the certainty of evidence was judged to be low to very low.

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Section: Discussionmentioning

confidence: 99%

Use of prokinetic agents in hospitalised adult patients: A scoping review

Crone

Møller

Bækgaard

et al. 2023

Acta Anaesthesiol Scand

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“…A recent systematic review addressed various definitions used in studies to define FI. It is described as high GRV or other gastrointestinal (GI) symptoms; however, different cut-off points for volumes and combinations with clinical symptoms cause intra-study variety [33 ▪▪ ]. Furthermore, Blaser et al [32] recommend that the FI-definition should comprise intake <80% of the target within the first 72 h of EN initiation and the presence of at least one GI-symptom while considering the optimization of non-EN-related factors (e.g., medication, GI-infection, and bowel anatomy).…”

Section: Feeding Intolerancementioning

confidence: 99%

Current insights in ICU nutrition: tailored nutrition

Hermans

Laarhuis²,

Kouw

et al. 2023

Current Opinion in Critical Care

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Purpose of reviewTo summarize recent research on critical care nutrition focusing on the optimal composition, timing, and monitoring of enteral feeding strategies for (post)-ICU patients. We provide new insights on energy and protein recommendations, feeding intolerance, and describe nutritional practices for coronavirus disease 2019 ICU patients.Recent findingsThe use of indirect calorimetry to establish individual energy requirements for ICU patients is considered the gold standard. The limited research on optimal feeding targets in the early phase of critical illness suggests avoiding overfeeding. Protein provision based upon the absolute lean body mass is rational. Therefore, body composition measurements should be considered. Body impedance analysis and muscle ultrasound seem reliable, affordable, and accessible methods to assess body composition at the bedside. There is inadequate evidence to change our practice of continuous enteral feeding into intermittent feeding. Finally, severe acute respiratory syndrome coronavirus 2 patients are prone to underfeeding due to hypermetabolism and should be closely monitored.SummaryNutritional therapy should be adapted to the patient's characteristics, diagnosis, and state of metabolism during ICU stay and convalescence. A personalized nutrition plan may prevent harmful over- or underfeeding and attenuate muscle loss. Despite novel insights, more research is warranted into tailored nutrition strategies during critical illness and convalescence.

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“…“Enteral feeding intolerance” (EFI) is often used to describe GI dysfunction in clinical practice and in the literature. Recent studies confirm that EFI is prevalent during critical illness and is strongly associated with adverse outcomes [1,6 ▪ ]. However, definitions used in the literature vary widely, and a uniform definition allowing conduction of interventional studies is lacking.…”

Section: Definition and Management Of Feeding Intolerancementioning

confidence: 99%

“…A recent systematic review identified gastric residual volumes with different cut-offs as the most frequently used item to define EFI (followed by other GI symptoms and achievement of energy target with EN) [6 ▪ ]. The authors proposed failed energy target (<80% of prescribed target within 72 h) as the main component to define EFI in the future [6 ▪ ]. Laudably, the authors proposed two additional components to this definition (presence of at least one GI symptom and consideration of any non-EN-related factors).…”

Section: Definition and Management Of Feeding Intolerancementioning

confidence: 99%

Gastrointestinal function in critically ill patients

Blaser

Bachmann

Deane

2023

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Purpose of review To summarize recent evidence regarding the diagnosis of acute gastrointestinal dysfunction and enteral feeding intolerance, and relationship of these to development of multiple organ dysfunction syndrome, during critical illness. Recent findings Novel gastric feeding tubes that attenuate gastroesophageal regurgitation or facilitate continuous monitoring of gastric motility have been developed. The definition of enteral feeding intolerance remains controversial, which may be resolved using a consensus process. A novel scoring system for gastrointestinal dysfunction (GIDS – GastroIntestinal Dysfunction Score) was recently developed but it is not yet validated or tested to evaluate the effect of any interventions. Studies of biomarkers to identify gastrointestinal dysfunction have yet to yield a suitable biomarker for daily clinical use. Summary The assessment of gastrointestinal function in critically ill patients continues to rely on complex daily clinical assessment. Scoring systems, consensus definitions and novel technology appear the most promising tools and interventions to improve patient care.

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A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults

Cited by 24 publications

References 115 publications

Use of prokinetic agents in hospitalised adult patients: A scoping review

Use of prokinetic agents in hospitalised adult patients: A scoping review

Current insights in ICU nutrition: tailored nutrition

Gastrointestinal function in critically ill patients

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