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How Well Do Critically Ill Patients Tolerate Early, Intragastric Enteral Feeding? Results of a Prospective, Multicenter Trial

Department of Medicine, Queen's University, Kingston, Ontario, Canada

Elsie Konopad, RN

Department of Critical Care

Cathy Alberda, RD

Nutritional Services, Royal Alexandra Hospital, Edmonton, Alberta, Canada

Laurie Keefe, RD

Nutritional Services, Kingston General Hospital, Kingston, Ontario, Canada

Carmelle Cooper, RD

Nutritional Services, University of Alberta Hospital, Edmonton, Alberta, Canada

Barbara Cantwell, RD

Critical Care Program, Hamilton Health Sciences Corporation—McMaster Site, Hamilton, Ontario, Canada

Objective: To evaluate whether critically ill patients tolerate early, intragastric enteral feedings. Design: Multicenter, prospective cohort study. Setting: Eight mixed intensive care units at tertiary care hospitals. Patients: We recruited mechanically ventilated critically ill patients expected to remain ventilated >48 hours. We enrolled 120 patients; the feeding protocol was used in 95. Forty percent were women, the mean age was 55.1 ± 18.9 years, and the mean APACHE II score was 21.6 ± 70.6. Interventions: We used a standardized feeding protocol that initiated enteral nutrition (EN) within 48 hours of admission at 25 mL/h and checked gastric residuals every 4 hours. At every 4-hour interval, the feeding rate was increased by 25 mL/h to the target rate, if the residual volume was <200 mL. If the residual volume was >200 mL, the feedings were discontinued temporarily. All patients were fed in the stomach. Motility agents were allowed if the patient had high gastric residuals. Main outcomes: Time elapsed from admission to the intensive care unit (ICU) to initiation of EN, tolerance (amount of EN received over the amount needed to receive to meet energy requirements), gastrointestinal dysfunction (eg, high gastric residuals), and ICU-acquired pneumonia. Results: Patients were started on EN 35.2 ± 15.6 hours after admission. Fifty-nine of 95 (62%) received >90% of their energy requirements for >2 consecutive days. Over the entire study period the average tolerance was 65.9%. Reasons why EN was interrupted or delayed included high gastric residuals, procedures, feeding tube problem, and diarrhea. The incidence of pneumonia in this cohort was 10 of 95 or 10.5%. Conclusions: Early intragastric EN is safe and feasible and is tolerated in a majority of critically ill patients. High gastric residuals represents a major obstacle to success.

Nutrition in Clinical Practice, Vol. 14, No. 1, 23-28 (1999)
DOI: 10.1177/088453369901400105


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