Effects of an Enteral Feeding Program on Nutrition-Related Outcomes in Critically Ill Medical Patients

Abstract

Introduction Malnutrition among critically ill medical patients is a major yet often overlooked problem. Despite its high prevalence, it signif icantly impacts clinical outcomes, including prolonged hospital stays, increased risk of complications, and higher mortality rates. Systematic and appropriate nutritional management in this patient group not only enhances the efficiency of enteral feeding but also reduces risks, improves safety, and contributes to faster recovery and better nutritional outcomes. 

Objective This study aimed to investigate the effects of an enteral feeding program for critically ill medical patients by comparing their outcomes with those of patients receiving standard enteral feeding care. The primary outcomes evaluated included the percentage of targeted energy intake achieved during the specified period, the average time to initiation of enteral feeding, and the incidence of complications including aspiration, diarrhea, and gastric residual volumes (GRV).

Design This study employed a quasi-experimental, two-group repeated measures design. The conceptual framework guiding this study was adapted from Van Blarcom’s Nutrition Bundle including six systematic steps: (1) assessing patients’ nutrition status to identify those at risk for malnutrition by conducting an initial screening to pinpoint high-risk individuals and formulate an appropriate care plan; (2) initiating and maintaining enteral nutrition by promoting early feeding within 24 to 48 hours of achieving hemodynamic stability and systematically planning the regimen; (3) reducing risks for aspiration through preventive measures such as maintaining Fowler’s position, verifying feeding tube placement, and appropriately assessing GRV; (4) implementing enteral feeding protocols and avoiding the use of gastric residual volumes as the strict determinant for feeding tolerance, advocating instead for continuous feeding even when certain levels of GRV are detected within safe clinical thresholds; (5) considering parenteral nutrition early when enteral feedings cannot be initiated; and (6) evaluating nutrition outcomes and complications to continuously monitor the intervention’s efficacy and overall patient safety.

Methodology The sample consisted of 36 patients admitted to a medical semi-intensive care unit at a university hospital in Northeastern Thailand between June and September 2024. Purposive sampling was employed to select participants based on inclusion criteria. The required sample size was determined through power analysis. The participants were purposively allocated into either an experimental group or a control group, with 18 participants in each arm. The research instruments consisted of three primary components: (1) the enteral feeding program for critically ill medical patients, (2) a demographic data recording form, and (3) an enteral feeding data recording form. The enteral feeding program underwent content validity testing by a panel of f ive experts, achieving a Content Validity Index (CVI) of 1.0. Furthermore, a feasibility study of the program was conducted by f ive nurses actively practicing in the medical semi-intensive care unit. Data were analyzed using descriptive statistics, Independent t-tests, Incidence Rate Differences, and Two-way Repeated Measures Analysis of Variance.

Results The majority of the participants in both the control and experimental groups were male (67% and 83%, respectively). The mean ages were 69.39 years (SD = 14.98) for the control group and 72.56 years (SD = 10.82) for the experimental group. The mean Body Mass Index (BMI) was 21.96 kg/m² (SD = 6.62) and 22.16 kg/m² (SD = 4.25), respectively. Clinical severity, measured by mean Acute Physiology and Chronic Health Evaluation II (APACHE II scores), was 21.72 (SD = 5.52) in the control group and 22.16 (SD = 5.27) in the experimental group. The mean nutritional risk scores, assessed using the Nutrition Alert Form (NAF), were 16.50 (SD = 3.15) and 16.05 (SD = 3.78), respectively. A baseline comparison of these demographic and clinical characteristics revealed no statistically signif icant differences between the two groups. After the program, the experimental group achieved a signif icantly higher percentage of energy intake relative to their targeted energy requirements during the specif ied period compared to the control group (η2p = .402, p < .001). Furthermore, the mean time to initiate enteral feeding was signif icantly shorter in the experimental group (t = 9.004, p = .001). The incidence of complications was also signif icantly lower in the experimental group compared to the control group, including aspiration (IRD = -47.62, 95% CI = -91.62, -3.62; p = .034), diarrhea (IRD = -87.30, 95% CI = -165.08, -9.53; p = .027), and gastric residual volumes (η2p  = .075, p = .047). 

Recommendation Nurses working in medical intensive care units with similar contexts to this study can implement this program into their practice. The application of this program should emphasize assessing patients’ readiness for feeding initiation, evaluating energy requirements in patients, and establishing specif ic targeted energy goals. Integrating these practices into patient care will facilitate patient recovery, mitigate the risk of complications, and enhance the overall eff iciency of critical care management.