Barriers to the delivery of enteral nutrition in pediatric intensive care units

Abstract

Background and Aim According to previously reported studies in the literature, a significant number of patients do not receive enteral nutrition in pediatric intensive care unit (PICU) because of avoidable barriers. Optimal nutrition is a fundamental goal in PICU. This study aims to identify the barriers of enteral nutrition in PICU. Setting and Design A cross-sectional study of the results of a 25-item questionnaire-based survey distributed during the Annual International Critical Care Conference by the Saudi Critical Care Society. Methods and material A 7-point Likert-type scale was used to rank the participants’ responses, and the relative importance index (RII) approach was used to analyze the relative contribution of each indicator to its main theme. The factor and parallel analysis methods were used to assess the factorial and unidimensionality of the enteral feeding barriers scale. Results A total of 223 PICU healthcare workers from various intensive care settings responded to the survey. The top-three perceived barriers for commencing enteral feeding were due to the patient being hemodynamically unstable (M = 3.6 and SD = 1.70), delays and difficulties in obtaining small bowel access in patients not tolerating other types of enteral nutrition (M = 3.4 and SD = 1.52), or severe fluid restriction, particularly in postoperative cardiac surgery (M = 3.3 and SD = 1.59). The top perceived overall barriers to enteral feeding were the dietician-related issues (M = 3.3, SD = 1.32), barriers related to enteral feeding delivery (M = 3.16 and SD = 1.13), and medical practice-related (M = 3 and SD = 1.10) issues. The lowest reported overall barriers were the resource-related obstacles (M = 2.7 and SD = 1.26). Conclusion Being hemodynamically unstable and other dietician-related reasons were the top overall barriers in commencing enteral feeding.

Prevalence, Risk Factors and Impact of Nutrition Interruptions in Critically Ill Children

“…First, PICU caregivers must have specific knowledge and skills regarding nutritional support for critically ill children with heart disease. Second, the use of protein- and energy-enriched nutritional formula in cases of fluid restriction could also prove helpful [ 28 ]. Finally, the use of protocols that lead the clinician to guide nutrition support may also be useful to avoid malnutrition in this population.…”

“…Previous surveys have also found delays and difficulties in obtaining small bowel feeding access, severe fluid restriction, no insufficient dietitian support during evenings, weekends and holidays, delays to preparing or obtaining nonstandard enteral feeds or feeding pump shortages in the unit as other potential barriers [ 20 , 28 ]. However, we did not explore these potential causes, so future prospective studies could focus on these barriers.…”

Impact of malnutrition on the outcome of critically-ill children: A comprehensive narrative review

“…The condition of electrolyte imbalances and other metabolic discrepancies can be prevented if the approach to attain nutritional level is well calculated. Refeeding syndrome can be prevented by gradually increasing the nutritional delivery; this becomes a more cautious task in the case of severely malnutrition patients [27].…”