Abstract
BackgroundThe purpose of this study was to evaluate the daily feeding practice of enterally fed patients in an intensive care unit (ICU) and to study the impact of preset factors in reaching predefined optimal nutritional goals.MethodsThe feeding practice of all ICU patients receiving enteral nutrition for at least 48 hours was recorded during a 1-year period. Actual intake was expressed as the percentage of the prescribed volume of formula (a success is defined as 90% or more). Prescribed volume (optimal intake) was guided by protocol but adjusted to individual patient conditions by the intensivist. The potential barriers to the success of feeding were assessed by multivariate analysis.ResultsFour-hundred-and-three eligible patients had a total of 3,526 records of feeding days. The desired intake was successful in 52% (1,842 of 3,526) of feeding days. The percentage of successful feeding days increased from 39% (124 of 316) on day 1 to 51% (112 of 218) on day 5. Average ideal protein intake was 54% (95% confidence interval (CI) 52 to 55), energy intake was 66% (95% CI 65 to 68) and volume 75% (95% CI 74 to 76). Factors impeding successful nutrition were the use of the feeding tube to deliver contrast, the need for prokinetic drugs, a high Therapeutic Intervention Score System category and elective admissions.ConclusionThe records revealed an unsatisfactory feeding process. A better use of relative successful volume intake, namely increasing the energy and protein density, could enhance the nutritional yield. Factors such as an improper use of tubes and feeding intolerance were related to failure. Meticulous recording of intake and interfering factors helps to uncover inadequacies in ICU feeding practice.
Highlights
Protein energy malnutrition is a major problem in severely ill hypercatabolic patients in the intensive care unit (ICU) [1]
Four-hundred-and-three eligible patients had a total of 3,526 records of feeding days
Average ideal protein intake was 54% (95% confidence interval (CI) 52 to 55), energy intake was 66% and volume 75%
Summary
Protein energy malnutrition is a major problem in severely ill hypercatabolic patients in the intensive care unit (ICU) [1]. Enteral nutrition has improved with regard to techniques, materials and composition, and has gained popularity because of its lower cost and lower rate of complications compared with parenteral nutrition. This is reflected in our intensive care by an increased use of enteral nutrition from 16.7% of total patient days in 1992 to 53.8% in 2001, and a slightly decreased use of parenteral nutrition, from 19% of total patient days in 1992 to 14% in 2001. The purpose of this study was to evaluate the daily feeding practice of enterally fed patients in an intensive care unit (ICU) and to study the impact of preset factors in reaching predefined optimal nutritional goals
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