Is early enteral feeding in critical care feasible in the United Kingdom?

Abstract

Enteral feeding is beneficial for preservation of gut integrity and regulation of immune-cell function [1]. Critically ill patients tend towards catabolism, and early enteral feeding has been found to reduce mortality in mechanically ventilated patients [2]. Other studies have also showed association with decreased mortality and decreased hospital and intensive care length of stay [3]. Our retrospective study in St George's General Intensive Care Unit (GICU) in London looked at whether we were meeting current guidelines on early enteral feeding. Local guidelines instruct for feeding within 12 hours but current European Society of Parenteral and Enteral Nutrition Guidelines (ESPEN) 2006 recommend feeding within 24 hours. We looked at the timing of feeding of patients admitted into the unit over a 6 week period. We defined early feeding as enteral feeding within 24 hours of admission and late feeding as feeding after 48 hours. In a 6 week period, 129 new patients were admitted into the 18 bedded GICU. 38 (29.5%) patients were elective post-operative patients versus 91 (70.5%) emergency admissions. Overall, 107 (82.9 %) patients were fed early. Feeding was mainly via the non-invasive oral route (56.6%) or nasogastric route (42.6%). Only one patient was fed via percutaneous endoscopic gastrostomy. In the elective admissions group, 35 (92%) patients were fed early vs 72 (79%) in the emergency group. Reasons for late feeding include patient declining feed, early return to theatre and slow communication with parent teams for clarification on feeding regime. Patients who were newly established on enteral feeding received the local standard starting regime. We hypothesise that early feeding was achieved in 83% of patients due to the stricter local guidelines. Feeding delay occurs more often in emergency admissions. When there are no contraindications, early feeding should be considered due to the benefits. Our results indicate that early enteral feeding in tertiary intensive care units in the UK is achieveable.