Enteral Feeding in Surgical Critically Ill Patients
Abstract
Objective: To study current practice in prescribing enteral nutrition for surgical critically ill patients and to identify factors associated with the initiation, successful or tolerance to enteral nutrition and mortality related to feeding character.
Patients and Methods: Forty-four ventilator supported patients who were expected to stay in the ICU for more than 3 days with retained nasogastric tube in surgical intensive care unit, Siriraj Hospital and Faculty of Medicine, were enrolled in this prospective cohort study. Patients who tolerated feeding were followed for at least 7 days or until 11 days if feeding were not tolerated. Patients were ceased to follow-up if they were discharged from the ICU, changed to the other route of feeding, or expired. Time from ICU admission to initiation and tolerance of enteral feeding was recorded and factors associated with these events were examined. We defined tolerance or successful as being able to receive 80% of estimated daily energy requirement for more than 48 hours without gastrointestinal dysfunction (ie, high gastric residuals, vomiting, diarrhea, abdominal distention) and early feeding as the initiation of enteral feeding within 72 hrs after admission to ICU.
Results: All patients were started on enteral feeding with the median time of 4.5 days after admission. The main reasons for late enteral feeding included post-operative abdominal surgery (46.2%), post-operative neurosurgery (30.8%) and absent bowel sound (26.9%). The time required to reach nearly 80% of energy requirement was about 6-7 days after admission. Twenty out of 44 patients (45.4%) achieved tolerance of the regimen. Once started, the enteral feeding was decreased or discontinued if patients experienced gastrointestinal dysfunction or had feeding time longer than 3 days and we found that the most common reason is gastrointestinal dysfunction (37.5%) with the top three reasons being high gastric residuals, abdominal distention and absence of bowel sound. The median time of successful feeding in patients who were on feeding longer than 3 days was 4.5 days (average 4.5 ± 0.57 days). Major reasons for termination of follow-up in non-successful feeding were tolerance of feeding (21.05%), follow-up for more than 10 days (26.31%) and being discharged from ICU (42.11%). We found that in all patients, survival was not correlated with successful or tolerance of feeding and early or late enteral feeding (p = 0.48 and 0.29 respectively). On the other hand, the early feeding group was significantly correlated with successful of feeding (p = 0.019).
Conclusions: Enteral nutrition is not started early in all surgical ICU patients. Approximately half of all patients receiving enteral nutrition achieved tolerance or successful feeding. Post-operative abdominal surgery is the most common reason for delay feeding while gastrointestinal dysfunction causing intolerance to enteral nutrition is the most common reason for discontinuing feeding.
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