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Energy‐Dense Formulae May Slow Gastric Emptying in the Critically Ill
Author(s) -
Kar Palash,
Plummer Mark P.,
Chapman Marianne J.,
Cousins Caroline E.,
Lange Kylie,
Horowitz Michael,
Jones Karen L.,
Deane Adam M.
Publication year - 2016
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607115588333
Subject(s) - gastric emptying , calorie , medicine , interquartile range , critically ill , parenteral nutrition , enteral administration , stomach , intensive care unit , meal , gastroenterology , anesthesia
Background: Enteral feed intolerance occurs frequently in critically ill patients and can be associated with adverse outcomes. “Energy‐dense formulae” (ie, >1 kcal/mL) are often prescribed to critically ill patients to reduce administered volume and are presumed to maintain or increase calorie delivery. The aim of this study was to compare gastric emptying of standard and energy‐dense formulae in critically ill patients. Methods : In a retrospective comparison of 2 studies, data were analyzed from 2 groups of patients that received a radiolabeled 100‐mL “meal” containing either standard calories (1 kcal/mL) or concentrated calories (energy‐dense formulae; 2 kcal/mL). Gastric emptying was measured using a scintigraphic technique. Radioisotope data were collected for 4 hours and gastric emptying quantified. Data are presented as mean ± SE or median [interquartile range] as appropriate. Results : Forty patients were studied (n = 18, energy‐dense formulae; n = 22, standard). Groups were well matched in terms of demographics. However, patients in the energy‐dense formula group were studied earlier in their intensive care unit admission ( P = .02) and had a greater proportion requiring inotropes ( P = .002). A similar amount of calories emptied out of the stomach per unit time ( P = .57), but in patients receiving energy‐dense formulae, a greater volume of meal was retained in the stomach ( P = .045), consistent with slower gastric emptying. Conclusions : In critically ill patients, the administration of the same volume of a concentrated enteral nutrition formula may not result in the delivery of more calories to the small intestine over time because gastric emptying is slowed.