Preventing diarrhoea in enteral nutrition: the impact of the delivery set hang time.

Abstract

To meet the current recommendations for enteral tube feeding (ETF), we updated our previous practice in 2011 and began to use a 24-h delivery set hang time (DSHT). We evaluated the impact of this update on the risk of diarrhoea and in diarrhoea-free survival. Observational, retrospective study with historical controls on ischaemic and haemorrhagic stroke patients undergoing ETF. Diarrhoea occurrence (≥3 liquid stools in 24h) was compared between patients with a 24h DSHT (2011-2014) and a 72/96h DSHT (2010-2011). The analysis was conducted using Kaplan-Meier curves and a Cox regression model. A total of 175 patients were included [median age 81years (IQR=12), 46.9% males], 103 in the group with a 24h DSHT and 72 in the group with a 72/96h DSHT. The group with a 24h DSHT had a lower diarrhoea frequency (13.6% vs. 34.7%, risk ratio: 0.39, 95% CI: 0.22-0.70, p=0.001) and a lower diarrhoea incidence rate (0.87 vs. 2.32 cases of diarrhoea/100 patient*day, rate ratio: 0.37, 95% CI: 0.19-0.72, p=0.004). The Kaplan-Meier curves showed a longer diarrhoea-free survival for this group (p=0.003, log-rank test). A 24h DSHT was associated with a lower risk of diarrhoea (HR=0.27, 95% CI: 0.12-0.61, p=0.002), adjusted by albumin, stroke severity, intravenous thrombolysis, the administration of clindamycin and cefotaxime, and the administration of an enteral formula for diabetic patients. The 24h DSHT was independently associated with a lower risk of diarrhoea and longer diarrhoea-free survival in hospitalised patients with acute stroke under ETF, compared with a 72/96h DSHT.