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How Well Do Critically Ill Patients Tolerate Early, Intragastric Enteral Feeding? Results of a Prospective, Multicenter Trial
Author(s) -
Heyland Daren K.,
Konopad Elsie,
Alberda Cathy,
Keefe Laurie,
Cooper Carmelle,
Cantwell Barbara
Publication year - 1999
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1177/088453369901400105
Subject(s) - medicine , enteral administration , intensive care unit , prospective cohort study , parenteral nutrition , intensive care , pneumonia , critically ill , mechanical ventilation , emergency medicine , intensive care medicine , anesthesia
Objective : To evaluate whether critically ill patients tolerate early, intragastric enteral feedings. Design : Multicenter, prospective cohort study. Setting : Eight mixed intensive care units at tertiary care hospitals. Patients : We recruited mechanically ventilated critically ill patients expected to remain ventilated >48 hours. We enrolled 120 patients; the feeding protocol was used in 95. Forty percent were women, the mean age was 55.1 ± 18.9 years, and the mean APACHE II score was 21.6 ± 70.6. Interventions: We used a standardized feeding protocol that initiated enteral nutrition (EN) within 48 hours of admission at 25 mL/h and checked gastric residuals every 4 hours. At every 4‐hour interval, the feeding rate was increased by 25 mL/h to the target rate, if the residual volume was <200 mL. If the residual volume was >200 mL, the feedings were discontinued temporarily. All patients were fed in the stomach. Motility agents were allowed if the patient had high gastric residuals. Main outcomes : Time elapsed from admission to the intensive care unit (ICU) to initiation of EN, tolerance (amount of EN received over the amount needed to receive to meet energy requirements), gastrointestinal dysfunction (eg, high gastric residuals), and ICU‐acquired pneumonia. Results : Patients were started on EN 35.2 ± 15.6 hours after admission. Fifty‐nine of 95 (62%) received >90% of their energy requirements for >2 consecutive days. Over the entire study period the average tolerance was 65.9%. Reasons why EN was interrupted or delayed included high gastric residuals, procedures, feeding tube problem, and diarrhea. The incidence of pneumonia in this cohort was 10 of 95 or 10.5%. Conclusions : Early intragastric EN is safe and feasible and is tolerated in a majority of critically ill patients. High gastric residuals represents a major obstacle to success.