Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness.

Abstract

BACKGROUND:

We aimed to determine the incidence of enteral feed intolerance and factors associated with intolerance and to assess the influence of intolerance on nutrition and clinical outcomes.

METHODS:

We conducted a retrospective analysis of data from an international observational cohort study of nutrition practices among 167 intensive care units (ICUs). Data were collected on nutrition adequacy, ventilator-free days (VFDs), ICU stay, and 60-day mortality. Intolerance was defined as interruption of enteral nutrition (EN) due to gastrointestinal (GI) reasons (large gastric residuals, abdominal distension, emesis, diarrhea, or subjective discomfort). Logistic regression was used to determine risk factors for intolerance and their clinical significance. A sensitivity analysis restricted to sites specifying a gastric residual volume ≥200 mL to identify intolerance was also conducted.

RESULTS:

Data from 1,888 ICU patients were included. The incidence of intolerance was 30.5% and occurred after a median 3 days from EN initiation. Patients remained intolerant for a mean (±SD) duration of 1.9 ± 1.3 days . Intolerance was associated with worse nutrition adequacy vs the tolerant (56% vs 64%, P < .0001), fewer VFDs (2.5 vs 11.2, P < .0001), increased ICU stay (14.4 vs 11.3 days, P < .0001), and increased mortality (30.8% vs 26.2, P = .04). The sensitivity analysis demonstrated that intolerance remained associated with negative outcomes. Although mortality was greater among the intolerant patients, this was not statistically significant.

CONCLUSIONS:

Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes.

• Authors: Usha Gungabissoon, Kimberley Hacquoil, Chanchal Bains, Michael Irizarry, George Dukes, Russell Williamson, Adam M Deane, Daren K Heyland
• Journal: JPEN. Journal of parenteral and enteral nutrition (JPEN J Parenter Enteral Nutr) Vol. 39 Issue 4 Pg. 441-8 (May 2015) ISSN: 1941-2444 [Electronic] United States
• PMID: 24637246 (Publication Type: Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 American Society for Parenteral and Enteral Nutrition.

Chemical References

• Gastrointestinal Agents

Topics

• Adult
• Aged
• Critical Illness (mortality, therapy)
• Enteral Nutrition (adverse effects)
• Female
• Gastric Emptying
• Gastrointestinal Agents (therapeutic use)
• Gastrointestinal Diseases (drug therapy, epidemiology, etiology)
• Hospital Mortality
• Humans
• Intensive Care Units
• Length of Stay
• Logistic Models
• Male
• Malnutrition (epidemiology, etiology)
• Middle Aged
• Nutritional Status
• Prevalence
• Respiration, Artificial
• Retrospective Studies
• Risk Factors