660 Prevalence, Risk Factors, and Clinical Consequence of Enteral Feeding Intolerance in the Critically Ill: An Analysis of a Multicenter, Multi-year Database

Abstract

Abstract Introduction We aimed to determine the incidence of enteral feed intolerance (EFI), factors associated with intolerance, and to assess the influence of intolerance on key nutritional and clinical outcomes in critically ill patients. Methods We used data from The International Nutrition Survey database collected from 2007–2014. Included patients were mechanically ventilated critically ill adults who remained in the Intensive Care Unit for at least 72 hours and received some enteral nutrition during the first 12 days of their ICU stay. Data collected included nutritional prescription, adequacy, and clinical otucomes. We defined EFI as feeding is interrupted due to one of the following reasons: high gastric residual volumes (GRV), increased abdominal girth or abdominal distension, vomiting/emesis, diarrhea or subjective discomfort. Logistic regression controlling for covariates (year, region, sex, APACHE II score, admission type by primary diagnosis, BMI and baseline caloric and protein prescriptions) was used to determine risk factors for intolerance and its clinical significance. Results The current analysis included 15, 918 patients from 775 ICUs. Of these, 4, 036 (25.4%) had at least one episode of EFI. The rate rose from just below 1% on day 1 to a peak of 6% on day 4 and 5 and declined daily thereafter (See Figure). Factors predictive of EFI are shown in Table 1. Admission diagnosis was significantly predictive of EFI with patients with burn injuries showing the highest incidence. After controlling for the covariates,patients who had EFI received about 10% less EN adequacycompared to patients without of EFI (see Table 2). The mortality rate in EFI patients was 31% vs. 24% among patients who did not have EFI (OR=1.5 [95% CI, 1.4–1.6] p< 0.0001). Patients who had EFI had fewer ventilator free days, longer ICU lengths of stay, and longer time to discharge alive (all p< 0.0001) (See Table 2). Conclusions Intolerance occurs frequently during enteral nutrition in the critically ill and is associated with poorer nutritional and clinical outcomes. The identification, prevention, and optimal management in burn injured patients may improve nutrition delivery and clinical outcomes in this important “at risk” population. Applicability of Research to Practice To improve the nutrition therapy in burns patients.