Optimal Time and Target for Evaluating Energy Delivery after Adjuvant Feeding with Small Bowel Enteral Nutrition in Critically Ill Patients at High Nutrition Risk

Abstract

Small bowel enteral nutrition (SBEN) may improve nutrient delivery to critically ill patients intolerant of gastric enteral nutrition. However, the optimal time and target for evaluating SBEN efficacy are unknown. This retrospective cohort study investigates these parameters in 55 critically ill patients at high nutrition risk (modified NUTRIC score ≥ 5). Daily actual energy intake was recorded from 3 days before SBEN initiation until 7 days thereafter. The energy achievement rate (%) was calculated as follows: (actual energy intake/estimated energy requirement) × 100. The optimal time was determined from the day on which energy achievement rate reached >60% post-SBEN. Assessment results were as follows: median APACHE II score, 27; SOFA score, 10.0; modified NUTRIC score, 7; and median time point of SBEN initiation, ICU day 8. The feeding volume, energy and protein intake, and achievement rate (%) of energy and protein intake increased significantly after SBEN (p < 0.001). An energy achievement rate less than 65% 3 days after SBEN was significantly associated with increased mortality after adjusting for confounding factors (odds ratio, 4.97; 95% confidence interval, 1.44–17.07). SBEN improves energy delivery in critically ill patients who are still at high nutrition risk after 1 week of stomach enteral nutrition.

Comparison of Feeding Efficiency and Hospital Mortality between Small Bowel and Nasogastric Tube Feeding in Critically Ill Patients at High Nutritional Risk

“…However, the right time to shift from NGEN to SBEN remains unclear in the current guidelines. Regarding actual clinical practice, we conduct a feeding protocol to evaluate the energy intake achievement rate at the end of the first week of an ICU stay, and this evaluation enables initiation of SBEN on the eighth ICU day as an option in ICU care [ 8 ]. Therefore, all patients enrolled in the present cohort had high mNUTRIC score (median mNUTRIC score, 7; IQR, 5.25–8) and low energy intake achievement rate (<50% of the target goal or feeding volume < 750 mL/day) even though NGEN was started within 48 h of ICU admission.…”

“…The secondary outcome was factors associated with hospital mortality in ICU patients with mNUTRIC score ≥ 5 and feeding volume < 750 mL/day. We also validated the power of hospital mortality prediction in this setting because an energy achievement rate of < 65% on the third day after the index date (the 10th ICU day) was demonstrated to be an outcome predictor in our other study [ 8 ].…”

“…Daily energy intake was recorded from the index day (the seventh ICU day) until 7 days later (the 14th ICU day). As in our previous report [ 8 ], the serial nutrition parameters 3 days after the index date were employed to compare the feeding efficiency of the SBEN and NGEN groups. Feeding efficiency was evaluated by the following six parameters: (1) actual feeding volume (mL/day), (2) actual energy intake (kcal/day), (3) actual protein intake (g/day), (4) actual protein intake (g/kg/body weight (BW)), (5) energy intake achievement rate (%), and (6) protein intake achievement rate (%).…”

“…Our previous study suggested the evaluation of the role of SBEN on the seventh day of the ICU stay for those with energy achievement rates of less than 60% [ 9 ]. We demonstrated that the feeding volume and achievement rates (%) of protein and energy intake were significantly higher after SBEN on the 10th day of the ICU stay [ 8 ]. We also found that an energy achievement rate lower than 65% on the third day after SBEN (the 10th day of the ICU stay) increased the mortality risk by a factor of 4.97 [ 8 ].…”

“…We demonstrated that the feeding volume and achievement rates (%) of protein and energy intake were significantly higher after SBEN on the 10th day of the ICU stay [ 8 ]. We also found that an energy achievement rate lower than 65% on the third day after SBEN (the 10th day of the ICU stay) increased the mortality risk by a factor of 4.97 [ 8 ]. However, whether SBEN should be routinely used instead of NGEN for undernourished critically ill patients and to improve the hospital mortality remains unclear.…”