Enteral nutrition discontinuation and outcomes in general critically ill patients

Abstract

OBJECTIVE:To determine the relationship between enteral nutrition discontinuation and outcome in general critically ill patients.MATERIALS AND METHODS:All patients admitted to a mixed intensive care unit in a tertiary care hospital from May-August 2009 were screened for an indication for enteral nutrition. Patients were followed up until leaving the intensive care unit or a maximum of 28 days. The gastrointestinal failure score was calculated daily by adding values of 0 if the enteral nutrition received was identical to the nutrition prescribed, 1 if the enteral nutrition received was at least 75% of that prescribed, 2 if the enteral nutrition received was between 50-75% of that prescribed, 3 if the enteral nutrition received was between 50-25% of that prescribed, and 4 if the enteral nutrition received was less than 25% of that prescribed.RESULTS:The mean, worst, and categorical gastrointestinal failure scores were associated with lower survival in these patients. Age, categorical gastrointestinal failure score, type of admission, need for mechanical ventilation, sequential organ failure assessment, and Acute Physiologic and Chronic Health Evaluation II scores were selected for analysis with binary regression. In both models, the categorical gastrointestinal failure score was related to mortality.CONCLUSION:The determination of the difference between prescribed and received enteral nutrition seemed to be a useful prognostic marker and is feasible to be incorporated into a gastrointestinal failure score.

Gastrointestinal Dysfunction in Critical Illness: A Review of Scoring Tools

“…The other 2 studies could not be evaluated for quality since 1 was a study reported as an abstract awaiting full text publication, whereas the other was a commentary letter . Using the GRADE criteria, 4/12 studies scored “high” (score 4–5), 3/12 scored “low” (score 2), and 5/12 scored “very low” (score ≤1) . Using the NIH scale, 8/12 studies were of “fair” quality, 3/12 were “good,” and 1/12 study was “poor.” Based on ROBINS‐I quality classification, 10/12 studies scored “moderate risk of bias,” 1/12 scored “serious risk of bias,” 1/12 scored “low risk of bias,” and 1 study tool was developed from a randomized controlled clinical trial which scored “fair” using the Cochrane classification for randomized controlled trials …”

“…(1) Study type: 7 of 14 studies 35,[37][38][39]42,44,45 were prospective cohort studies including a risk stratification model 45 and a multimodal strategy management model 44 ; 1 was a retrospective cohort study 40 ; 2 were endorsed recommendations from AGI grading constructed based on a comprehensive quality-graded literature review and expert Figure 1. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow chart illustrating the search strategy and study selection process.…”

“…(ii) 2 clinical trials combined with clinician interviews using a comprehensive psychopathological rating scale (GSRS) 47 ; and (iii) a psychometric evaluation study including medical literature, focus groups, and clinician interviews (GCSI) 48 with their GDSTs' used aspects of QoL scales as part of the methodology. (2) Study design: 10 were single-centerd, 35,[37][38][39][40]42,[45][46][47][48] whereas only 1 study was conducted as a multicenter trial 48 ; 2 were endorsed recommendations 36,43 ; and 1 was a letter of response to an original article. 41 (Table 1).…”

“…41 Using the GRADE criteria, 4/12 studies scored "high" (score 4-5), 35,36,40,47 3/12 scored "low" (score 2), 37,39,43 and 5/12 scored "very low" (score ࣘ1). 38,42,44,46,48 Using the NIH scale, 8/12 studies were of "fair" quality, 35,37,39,42,44,[46][47][48] 3/12 were "good," 36,40,43 and 1/12 study was "poor." 38 Based on ROBINS-I quality classification, 10/12 studies scored "moderate risk of bias," [35][36][37]39,40,[42][43][44]46,48 1/12 scored "serious risk of bias," 38 1/12 scored "low risk of bias," 45 and 1 study tool was developed from a randomized controlled clinical trial 46 which scored "fair" using the Cochrane classification for randomized controlled trials.…”

“…Nine of the 14 studies correlatedGDSTs with organ or disease severity scores (eg, Simple Acute Physiologic Score, American Society of Anesthesiologists, MODS, and SOFA)35,37,40,42,[44][45][46][47][48] ; 3 studies correlated the GDSTs with QoL scores (eg, Comprehensive Psychopathological Rating Scale, Short Form 36 Health Survey, Spitzer Quality of Life Index, and the Bradburn Affect Balance Scale [46][47][48]. Five studies integrated their GDSTs into a MODS score (SOFA, SOFA subscores, European Score for Cardiac Operative Risk Evaluation, SOFA + APACHE, APACHE-II + SOFA) 35,[37][38][39][40]. Two grading scores were endorsed by consensus guidelines (European Society of Intensive Care Medicine and European Society of Parenteral and Enteral Nutrition) 36,43.…”