Enteral Nutrition in the Critically Ill

Marik, Paul E.

doi:10.1097/ccm.0000000000000051

Cited by 50 publications

(43 citation statements)

References 113 publications

(122 reference statements)

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“…It was notable, however, that nurses themselves perceived that inadequate knowledge, education and attitudes impacted enteral feeding. Marik () reviewed the evidence for commonly believed myths and misconceptions held by ICU staff who contribute to underfeeding.…”

Section: Discussionmentioning

confidence: 99%

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Tume

Latten

Kenworthy

2017

Nursing in Critical Care

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BackgroundMeasuring gastric residual volume (GRV) to guide enteral feeding is a common nursing practice in intensive care units, yet little evidence supports this practice. In addition, this practice has been shown to potentially contribute to inadequate energy delivery in intensive care, which remains a problem in critically ill children.. AimsWe aimed to explore paediatric intensive care nurses' decision-making surrounding this practice. MethodsA cross-sectional electronic survey in a single mixed general and cardiac surgical PICU in the UK. ResultsThe response rate was 59% (91/154) and responding nurses were experienced, with a mean PICU experience of 10.5 years (SD 8.09). The three main reasons for stopping or withholding enteral feeds were: the volume of gastric residual volume obtained (67%), the appearance of this gastric aspirate (40%) and the overall clinical condition of the child (23%). Most 2 nurses reported checking GRV primarily to determine 'feed tolerance' (97%) as well as confirming feeding tube position (94%). Nurses' perceived harms from high GRV were: the risk of pulmonary aspiration (44%), malabsorption of feeds (20%) and the risk of vomiting (19%). GRV was measured frequently in this PICU, with 58% measuring GRV before every feed, 27% measuring 4 hourly and 17% measuring 6 hourly.The majority of nurses (84%) stated they would be worried or very worried if they could not measure GRV routinely. ConclusionsPICU nurses' decision-making surrounding initiating and withholding enteral feeds, and determining 'feed tolerance' remains heavily based on GRV. PICU nurses' have significant fears around patient harm if they do not measure GRV routinely. Relevance to clinical practiceThis nursing practice is likely to be one of the factors that impair the delivery of enteral nutrition in critically ill children and as such its validity and usefulness needs to be challenged and studied in future research.

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Section: Discussionmentioning

confidence: 99%

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Tume

Latten

Kenworthy

2017

Nursing in Critical Care

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“…Similarly, ileus is a term lacking an agreed definition in the critically ill. It generally refers to hypomotility and a functional obstruction in the absence of a discreet luminal narrowing or stricture, usually including the small intestine, but any segment of the gastrointestinal tract can be implicated . Given the lack of an agreed definition, it is not surprising that ileus can be challenging to identify in clinical practice, with a range of possible signs, including abdominal distension, increased GRV, and absent bowel sounds .…”

Section: Clinical Presentation Of Dysmotilitymentioning

confidence: 99%

Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill

et al. 2018

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Gastrointestinal dysmotility causes delayed gastric emptying, enteral feed intolerance, and functional obstruction of the small and large intestine, the latter functional obstructions being frequently termed ileus and Ogilvie syndrome, respectively. In addition to meticulous supportive care, drug therapy may be appropriate in certain situations. There is, however, considerable variation among individuals regarding what gastric residual volume identifies gastric dysmotility and would encourage use of a promotility drug. While the administration of either metoclopramide or erythromycin is supported by evidence it appears that, dual‐drug therapy (erythromycin and metoclopramide) reduces the rate of treatment failure. There is a lack of evidence to guide drug therapy of ileus, but neither erythromycin nor metoclopramide appear to have a role. Several drugs, including ghrelin agonists, highly selective 5‐hydroxytryptamine receptor agonists, and opiate antagonists are being studied in clinical trials. Neostigmine, when infused at a relatively slow rate in patients receiving continuous hemodynamic monitoring, may alleviate the need for endoscopic decompression in some patients.

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“…2,4,7,12,16,20 It is proposed that early postoperative nutrition improves outcomes by reducing the metabolic stress associated with surgery, helping maintain better glycaemic control and hastening wound healing by favourably modulating the gut's immune response. 1,2,4,10,12,19,23,24 Findings from studies such as this one can be used to help direct future change; however, to do this, it is necessary to gain insight into barriers and enablers to the implementation of ERAS. 4,11,24,25 Previous investigations have reported that smaller hospitals face obstacles such as lack of time and resources to gain support for and to implement the necessary changes, as well as a certain reluctance amongst the multidisciplinary teams involved to alter their normal practice.…”

Section: Discussionmentioning

confidence: 99%

Delayed postoperative diet is associated with a greater incidence of prolonged postoperative ileus and longer stay in hospital for patients undergoing gastrointestinal surgery

Rees

Bobridge²,

Cash³

et al. 2017

Nutrition & Dietetics

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Enteral Nutrition in the Critically Ill

Abstract: A number of common myths and misconceptions appear to play a major role in limiting the provision of enteral nutrition in the critically ill. This article provides scientific data to debunk the most common myths and misconceptions related to enteral nutrition.

Cited by 50 publications

References 113 publications

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Paediatric intensive care nurses' decision‐making around gastric residual volume measurement

Pathophysiology and Treatment of Gastrointestinal Motility Disorders in the Acutely Ill

Delayed postoperative diet is associated with a greater incidence of prolonged postoperative ileus and longer stay in hospital for patients undergoing gastrointestinal surgery

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