Identification of risk factors for enteral feeding intolerance screening in critically ill patients

Abstract

Objectives:To identify risk factors for enteral feeding intolerance screening in critically ill patients, thereby, provide some reference for healthcare staff to assess the risk of feeding intolerance, and lay the foundation for future scale development.Methods:This study used a mixed methodology, including a literature review, semi-structured interviews, the Delphi technique, and the analytic hierarchy process. We used the literature review and semi-structured interviews (n=22) to draft a preliminarily item pool for feeding intolerance, Delphi technique (n=30) to screen and determine the items, and the analytic hierarchy process to calculate the weight of each item. The study was conducted between June 2014 and September 2015 in Daping Hospital, Third Military Medical University, Chongqing, China.Results:Twenty-three risk factors were selected for the scale, including 5 dimensions. We assigned a weight to each item according to their impact on the feeding intolerance, with a higher score indicating a greater impact. The weight of each dimension was decreasing as follows: patient conditions, weight score equals 42; general conditions, weight score equals 23; gastrointestinal functions, weight score equals 15; biochemical indexes, weight score equals 14; and treatment measures, weight score equals 6.Conclusion:Developed list of risk factors based on literature review, survey among health care professionals and expert consensus should provide a basis for future studies assessing the risk of feeding intolerance in critically ill patients.

Early introduction of a semi-elemental formula may be cost saving compared to a polymeric formula among critically ill patients requiring enteral nutrition: a cohort cost–consequence model

“…Patient status (e.g., injury severity score, multiple organ dysfunction score), general conditions (e.g., abdominal surgery), and GI function (e.g., acute gastrointestinal injury grade), as well as biochemical indexes and treatment measures, should be considered as they represent potential risk factors for feeding intolerance. 28 …”

Digestion-Specific Acupuncture Effect on Feeding Intolerance in Critically Ill Post-Operative Oral and Hypopharyngeal Cancer Patients: A Single-Blind Randomized Control Trial

“…After composite resection and free flap reconstruction, patients are admitted to intensive care units (ICUs) in order to allow for the close monitoring of flap and respiratory status [ 7 ]. These patients present with a number of risk factors that aggravate feeding intolerance, including postoperative status, prolonged bed ridden immobility, decreased head elevation (less than 30 °), mechanical ventilation, and the customary use of sedative agents [ 8 ]. Feeding intolerance is common in postoperative critically ill patients, and is conventionally related to poor outcomes.…”

Association between serum lactate levels and enteral feeding intolerance in septic patients treated with vasopressors: a retrospective cohort study

“…The pathogenesis of intestinal nutritional intolerance has yet to be fully explored. Possible mechanisms underlying intolerance to EN feeding include gastrointestinal nerve and smooth muscle injuries, inflammation, surgery, opioid use, electrolyte disturbance, and hyperglycemia (8,12). However, studies on the relevant risk factors are still controversial (7,12).…”

“…Possible mechanisms underlying intolerance to EN feeding include gastrointestinal nerve and smooth muscle injuries, inflammation, surgery, opioid use, electrolyte disturbance, and hyperglycemia (8,12). However, studies on the relevant risk factors are still controversial (7,12). Arabi et al (13) suggested that when EN is carried out for severe patients treated with vasopressors, attention must be paid to the occurrence of lactic acidosis, which may be an important indicator of parenteral ischemia.…”