Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals

Abstract

BackgroundThere is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery.MethodsThis cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained.ResultsA total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2–19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2–3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353–0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008–0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient – 0.002, 95% CI – 0.008 to − 0.001; p = 0.024) and male gender (coefficient – 0.144, 95% CI – 0.203 to − 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2–3 was associated with lower EN proportion (coefficient – 0.206, 95% CI – 0.273 to − 0.139; p < 0.001).ConclusionsThe study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.

Effect of early mobilization combined with early nutrition on acquired weakness in critically ill patients (EMAS): A dual-center, randomized controlled trial

“…Furthermore, despite the existence of nutrition guidelines for the critically ill, observance of these guidelines remains poor [ 39 ]. In a cross-sectional study across China [ 40 ], EN was found to be suboptimal in ICUs and energy targets were poorly met during the early days of ICU stay. It is likely that early nutrition is still not prevalent in the ICU setting, and it needs to be implemented as an intervention to investigate its effect on physical functioning (including muscle strength, function, and muscle mass) [ 41 ] when applied alone compared to when implemented in EMN.…”

Association between Domperidone Administered via Feeding Tube and Feeding Success in Critically Ill Patients with Enteral Feeding Intolerance

“…Compared with that study, the patients in the present study achieved lower rates of feeding success; however, this is partly due to patients' withdrawals in that study, resulting in a reduction in the number of patients remaining in the trial. Another study indicated that enteral nutrient delivery was suboptimal in Chinese ICUs because of a lack of or differences in standardized feeding protocols, which may make it difficult to compare the present data with other studies [27]. However, we adopted a volume-based feeding strategy, with reduced energy and increased protein density, which is popular in our hospital, perhaps because of a fear of hyperglycemia.…”

Novel Multiparametric Nomogram for Overall Survival Prediction in Complicated Intra-Abdominal Infection: A Multicenter Study in China

“…The Working Group on Abdominal Problems of the European Society of Intensive Care Medicine firstly developed the definitions of AGI with four grades of severity, making it possible to estimate the gastrointestinal function of critically ill patients ( 20 ). AGI is widely used in ICU ( 21 , 22 ). A multi-prospective study that recruited patients admitted to ICU diagnosed with AGI showed that AGI grading was positively correlated with all-cause mortality ( 23 , 24 ).…”