Outcomes Associated With Enteral Tube Feedings in a Medical Intensive Care Unit

Abstract

• Background Underfeeding of patients reliant on enteral tube feedings most likely is due primarily to interruptions in the infusions. Strategies to improve energy intake require an understanding of such interruptions and associated outcomes. • Objectives To compare daily energy intake with goal energy intake; to ascertain frequency, duration, and reasons for interruptions in feedings; and to determine occurrences of feeding intolerance. • Methods A prospective, descriptive study of a convenience sample of patients admitted during a 3-month period to a medical intensive care unit. Patients were included who were expected to receive continuous enteral tube feedings for at least 48 hours. Patients were studied until discontinuation of feedings, discharge from the unit, or death. • Results Thirty-nine patients were studied for 276 feeding days. Patients received a mean of 64% of goal energy intake. Mean length of interruptions in feeding was 5.23 hours per patient per day. Interruptions for performance of tests and procedures accounted for 35.7% of the total cessation in feeding time. Next most time-consuming interruptions occurred with changes in body position (15%), unstable clinical conditions (13.5%), high gastric residual volume (11.5%), and nausea and vomiting (9.2%). Patients had diarrhea 105 (38%) of 276 feeding days. Gastric residual volumes exceeded 150 mL on 28 measurements in 11 patients. Five patients experienced episodes of nausea and vomiting. Four patients experienced an episode of feeding aspiration. • Conclusions Precautionary interruptions in enteral feedings to decrease presumed risk of aspiration occurred frequently and resulted in underfeeding. Episodes of vomiting and of aspiration were uncommon.

Effect of Feeding‐Tube Properties on Residual Volume Measurements in Tube‐Fed Patients

“…For example, a GRV of Ն150 mL has been cited as significant by several authors. 1,4 Very low small-bowel residual volumes (usually Ͻ10 mL) during feedings have been reported by other investigators. 21,22 Because of these typically low values, small-bowel residual-volume measurements are rarely performed during small-bowel feedings.…”

“…For example, one group of investigators used only 14 Fr-silicone tubes, 6 whereas another used a mixture of large-diameter (14 Fr or 16 Fr) orogastric sump tubes and small-diameter (10 Fr or 12 Fr) feeding tubes. 1 It is noteworthy that a GRV Ն500 mL was described as significant by a group of investigators who used only large-diameter (14 Fr) tubes. 6 Similarly, the largest GRV (775 mL) reported by Elpern et al 1 was obtained from a large-diameter (16 Fr) tube.…”

“…Tube-feeding protocols usually call for frequent measurements of gastric residual volume (GRV) to assess intolerance to feedings and likelihood of aspiration, presumably by estimating gastric emptying. [1][2][3] Although the paracetamol absorption test is more accurate for this purpose, it is impractical for regular use. Likewise, other methods of measuring gastric emptying (eg, radionuclide gastric emptying studies) are rarely indicated.…”

The Use of Prealbumin and C‐Reactive Protein for Monitoring Nutrition Support in Adult Patients Receiving Enteral Nutrition in an Urban Medical Center

“…1 Interruption in the delivery of enteral nutrition (EN) for tests and procedures may lead to an increased risk of malnutrition in hospitalized patients. [4][5][6][7][8][9][10] The delivery of adequate nutrients can help prevent or reverse the effects of malnutrition. However, accurate methods are needed to monitor the adequacy of nutrition support.…”

Preventing diarrhoea in enteral nutrition: the impact of the delivery set hang time

“…Third, the lack of a unified definition of diarrhoea is a common limitation in this type of study and it hinders comparisons between them (30,31). We used the definition of the World Health Organization (20), since it has been a widely used definition by several authors over the last 10 years (2,6,23,(31)(32)(33)(34)(35).…”