Defining and Assessing Tolerance in Enteral Nutrition

Bernard, Andrew C.; Magnuson, Barbara; Swintosky, Marjorie; Barnes, Stephen L.; Kearney, Paul A.

doi:10.1177/0115426504019005481

Cited by 16 publications

(18 citation statements)

References 33 publications

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“…(3,4) Some intercurrences during ENT administration are known to eventually cause temporary and/or permanent enteral nutrition discontinuation, preventing the appropriate nutritional requirements supply (5) and, consequently, exposing the patient to malnutrition, which is prevalent in hospitalized patients. (6) Gastrointestinal complications (GICs) are intolerances frequently found in critically ill ENT patients, specially nausea/vomiting, diarrhea, constipation and high gastric residuals, with several studies confirming their high prevalence.…”

Section: Resultsmentioning

confidence: 99%

Complicações gastrointestinais e adequação calórico-protéica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva

Oliveira

Burgos

Santos

et al. 2010

Rev. bras. ter. intensiva

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Section: Resultsmentioning

confidence: 99%

Complicações gastrointestinais e adequação calórico-protéica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva

Oliveira

Burgos

Santos

et al. 2010

Rev. bras. ter. intensiva

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“…The enteral formula itself was once thought to contribute to diarrhea but it is not likely the cause. Most EN formulas are lactose‐free and are not exceedingly hypertonic to cause diarrhea 92 . TBI patients often receive electrolyte supplements, elixirs, and other medications that are extremely hypertonic compared with the EN.…”

Section: Facilitating Enteral Nutrition Tolerancementioning

confidence: 99%

“…Most EN formulas are lactose-free and are not exceedingly hypertonic to cause diarrhea. 92 TBI patients often receive electrolyte supplements, elixirs, and other medications that are extremely hypertonic compared with the EN. Many liquid medications are mixed or suspended in sorbitol diluents.…”

Section: Facilitating Enteral Nutrition Tolerancementioning

confidence: 99%

Nutrition Considerations in Traumatic Brain Injury

2008

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The provision of adequate nutrition support for patients with traumatic brain injury (TBI) has been a clinical challenge for decades. The primary and secondary injuries create unique metabolic derangements along with accompanying issues such as optimal timing and route of nutrition, appropriate fluid and electrolytes, drug administration, rehabilitation, and dysphagia. Enteral nutrition is clearly established as the preferential route of nutrition support for this population vs parenteral nutrition. There appears to be a consensus on early initiation of enteral nutrition, but less definitive are recommendations on advancement timing and formula components. Nutrition therapies should include exact fluid resuscitation goals specific for TBI and strict electrolyte monitoring to avoid extreme fluid, electrolyte, or glucose shifts that could be detrimental to the patient. While the critical care patient often tolerates small bowel feeding, the long-term rehabilitation patient should transition to and tolerate gastric feeding. Drug-nutrient and adverse drug reactions such as diarrhea should be routinely evaluated in patients receiving enteral nutrition. Monitoring for dysphagia is critical to avoid the costly negative aspects associated with aspiration and to capitalize on quality of life and appropriate oral nutrition. Emphasizing the priority of early nutrition support within a multi-disciplinary team may be the critical key for successful provision and tolerance of nutrition support in the TBI population.

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“…Success of a tube feeding regimen and adequate delivery of protein and other nutrients may also depend on patient tolerance. Tube feeding intolerance (TFI) can manifest itself in a number of ways and is most often described by the presence of 1 or more upper or lower gastrointestinal (GI) symptoms including nausea, vomiting, reflux, bloating, diarrhea, or constipation . Intolerance and GI symptoms can have a significant impact on patients, caregivers, and healthcare resources and may lead to reduced volumes of feeding delivered and resultant undernutrition and underhydration .…”

Section: Introductionmentioning

confidence: 99%

“…Tube feeding intolerance (TFI) can manifest itself in a number of ways and is most often described by the presence of 1 or more upper or lower gastrointestinal (GI) symptoms including nausea, vomiting, reflux, bloating, diarrhea, or constipation . Intolerance and GI symptoms can have a significant impact on patients, caregivers, and healthcare resources and may lead to reduced volumes of feeding delivered and resultant undernutrition and underhydration . Incidence of TFI in the ICU has been reported to range from 30%–60% and has been associated with nutrition deficits and adverse clinical outcomes including mortality and increased length of ICU stay …”

Section: Introductionmentioning

confidence: 99%

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

et al. 2019

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Background To meet protein needs in critical illness (CI), guidelines suggest ≥1.2–2.5 g protein/kg/d; however, most intensive care unit (ICU) patients receive ≤0.7 g/kg/d. Higher protein enteral nutrition (EN) formulas may be part of the solution to provide prescribed protein. Our objective was to demonstrate that an EN formula with 37% protein can deliver ≥80% of prescribed protein, without overfeeding calories within the first 5 days of feeding and to describe ICU clinicians' experience. Methods This quality improvement (QI) project included patients requiring exclusive EN for up to 5 days from 6 Canadian ICUs. Rationale for choosing formula, patient's BMI (kg/m2), nutrition targets, daily protein and energy delivered, feeding interruptions, and general tolerance were recorded. Results Forty‐four of 49 patients received the formula ≥2 days. Average protein prescribed was 137.5 g/d (82.5–200) or 1.9 g/kg/d (1.5–2.5). Average protein delivered was 116.9 g/d (33.5–180) or 1.6 g/kg/d (0.4–2.4). Seventy‐five percent to 83% of patients received ≥80% prescribed protein on days 2–5. Average energy prescribed was 1638.6 kcal/d (990–2500) or 17.8 kcal/kg (11–26). Average energy delivered was 1523.9 kcal/d (693.0–2557.5) or 17.3 kcal/kg/d (1.35–64.7). The formula was well tolerated with no gastrointestinal symptoms reported in 38 (86%) patients. The most common reasons to prescribe the formula were obesity and use of fat‐based medications. Conclusions We demonstrated in a QI study that a high‐protein EN formula was tolerated in a small, heterogeneous group of ICU patients and effective in meeting protein targets without overfeeding.

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Defining and Assessing Tolerance in Enteral Nutrition

Cited by 16 publications

References 33 publications

Complicações gastrointestinais e adequação calórico-protéica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva

Complicações gastrointestinais e adequação calórico-protéica de pacientes em uso de nutrição enteral em uma unidade de terapia intensiva

Nutrition Considerations in Traumatic Brain Injury

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

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