Enteral nutrition interruptions in critically ill patients: A prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay

Onuk, Sevda; Özer, Nurhayat Tuğra; Savas, Nilgun; Sipahioğlu, Hilal; Temel, Şahin; Ergul, Serap Sahin; Şahįn, Gülşah; Sungur, Murat; Güven, Muhammed; Gündoğan, Kürşat

doi:10.1016/j.clnesp.2022.10.019

Cited by 3 publications

(4 citation statements)

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“…Currently, there is a lack of quality management tools in clinical practice to monitor the rate of implementation of EN measures [5,6]. Previous studies have shown [12,13] that the reasons for ENI in ICU patients include hemodynamic instability, high GRV, and medical procedures. It is difficult to avoid ENI, but as shown by Kagan et al [36], the use of nutritional management feeding platforms (such as the smART + platform) can monitor ICU patients' ENI in real-time, calculate the amount of compensation needed when restarting, and ultimately help patients reach their EN goal.…”

Section: Discussionmentioning

confidence: 99%

“…Enteral nutrition interruption (ENI) [11] is defined as an interruption of EN lasting 1 h or more with continuous enteral feeding or if the patient does not receive the expected amount of nutrients within 30 min with intermittent enteral feeding. Studies have found [10] that the average ENI time for ICU patients is up to 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) hours per day. The causes of ENI are underestimated target feeding volumes, feeding intolerance, medical procedures, etc., which can be divided into patient factors and subjective factors [12,13].…”

Section: Introductionmentioning

confidence: 99%

“…Studies have found [10] that the average ENI time for ICU patients is up to 12 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) hours per day. The causes of ENI are underestimated target feeding volumes, feeding intolerance, medical procedures, etc., which can be divided into patient factors and subjective factors [12,13]. Among these, avoidable subjective factors related to medical operations account for approximately 72% of the total time of ENI [14,15].…”

Section: Introductionmentioning

confidence: 99%

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Cognitive influencing factors of ICU nurses on enteral nutrition interruption: a mixed methods study

Pan,

Zhang,

Yang

et al. 2024

BMC Nurs

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Background The incidence of clinically avoidable enteral nutrition interruptions is high. ICU nurses, as the implementers and monitors of enteral nutrition, have a close relationship between their cognitive level of enteral nutrition interruption and the incidence of enteral nutrition interruption. The level of ICU nurses’ cognition of enteral nutrition interruption and the key factors influencing the level of ICU nurses’ cognition of enteral nutrition interruption are not known. Objectives This study aims to explore the cognitive level of ICU nurses on enteral nutrition interruption and delve into the key factors that affect their cognitive level from the perspective of management. Design A sequential explanatory mixed methods research design was used. Methods With the convenience sampling method, an online survey questionnaire was distributed to ICU nurses in Chongqing, and 336 valid questionnaires were collected. After the survey, ICU managers were invited to participate in qualitative interviews, in which 10 participants from five hospitals completed face-to-face individual semi-structured interviews and were analyzed with thematic analysis. Results The survey found that ICU nurses had a good level of cognition towards enteral nutrition interruption but poor knowledge about the definition, causes, and consequences of enteral nutrition interruption, as well as negative attitudes toward active learning, assessment, and communication. And the longer work time in the ICU, joining the nutrition team, receiving systematic training, and acquiring relevant knowledge from academic journals more frequently were favorable to improving ICU nurses’ knowledge level of enteral nutrition interruption. Personal interviews further identified the key factors affecting their cognitive level, including (1) lack of knowledge, (2) lack of proactive thinking, (3) lack of enteral nutrition management programs, and (4) lack of quality management tools for enteral nutrition interruption. Conclusion Although ICU nurses demonstrate a relatively high level of cognition, there is still room for improvement. ICU administrators must take specific measures to improve the knowledge of ICU nurses, especially in non-tertiary hospitals, in order to prevent nurse-induced enteral nutrition interruption in all ICUs and improve medical quality. Trial registration Not applicable.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cognitive influencing factors of ICU nurses on enteral nutrition interruption: a mixed methods study

Pan,

Zhang,

Yang

et al. 2024

BMC Nurs

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“…The primary cause we identified was GRV monitoring, a common practice in ICU patients. Onuk et al, in a recent study, mentioned that radiological procedures were the most common reason for ENIs, with the longest ENIs being caused by tube feeding malfunctions during the first week of the ICU stay [ 32 ]. These findings were confirmed in Peev’s and O’Meara’s publications (ninety-four and fifty-nine mechanically ventilated patients, respectively) in the United States, highlighting that feeding tube problems are the most common cause of ENIs [ 33 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients

et al. 2023

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Background and Aim: Feeding interruptions in critical care patients are often unjustified. We aimed to determine the causes, duration, and frequency of enteral nutrition interruptions (ENIs) and to assess macronutrients and antioxidant deficits according to European Society of Parenteral Enteral Nutrition (ESPEN) guidelines. Methods: We prospectively enrolled Intensive Care Unit (ICU) patients admitted for more than 48 h with an inability to orally eat from April to December 2019. The type of enteral nutrition, the number of calories administered, the time of feeding initiation, the reasons for delaying feeding, and the causes for ENI were recorded. Results: 81 patients were enrolled, with a median duration of ENIs of 5.2 (3.4–7.4) hours/day. Gastric residual volume (GRV) monitoring—a highly controversial practice—was the most common cause of ENI (median duration 3 (2.3–3) hours/day). The mean energy intake was 1037 ± 281 kcal/day, while 60.5% of patients covered less than 65% of the total energy needs (1751 ± 295 kcal/day, according to mean Body Mass Index (BMI)). The median daily protein intake did not exceed 0.43 ± 0.3 gr/kg/day of the actual body weight (BW), whereas ESPEN recommends 1.3 gr/kg/day for adjusted BW (p < 0.001). The average administration of micronutrients and antioxidants (arginine, selenium, zinc, vitamins) was significantly less than the dietary reference intake (p < 0.01). Conclusion: ENIs lead to substantial caloric, protein, and antioxidant deficits.

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Understanding nursing perspective towards barriers to the optimal delivery of enteral nutrition in intensive care settings

Zaher,

Sumairi,

Ajabnoor

2024

BMC Nurs

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Background The management process of Enteral Nutrition (EN) typically involves the interaction between a team of health care practitioners. Nurses being the closest to the patients, have crucial responsibilities and play a major role in feeding delivery along with other medical treatments. This study was conducted to investigate the perception of the nurses working in adult and paediatric intensive care Units (ICUs) regarding the EN barriers and identify the factors that influenced their perception. Methods The data in this cross-sectional study was collected via online survey between 15 October 2021 and January 2022. All nurses working in adult or paediatric ICUs across Saudi Arabia were eligible to participate. The tool used for the data collection was adapted from Cahill et al. (2016) and then reviewed and modified by the researchers. The survey collected information about the demographics of the nurses, and it included 24 potential EN barriers where the participants were asked to rate their importance on a scale from 1 to 5. Descriptive statistics were performed to describe the variables, univariant analysis were performed to compare the perceptions of the nurses regarding the EN barriers based on their characteristics followed by stepwise linear regression analysis. Results A total of 136 nurses working in adult and paediatric ICUs were included in this study. The results showed that the most important barriers as perceived by the nurses was “Frequent displacement of feeding tube, requiring reinsertion” [3.29 ± 1.28], “Delays in initiating motility agents in patients not tolerating enteral nutrition” [3.27 ± 1.24] and “Enteral formula not available on the unit”. [3.27 ± 1.24]. Our results showed that the responses of the participants statistically varied based on their work settings, gender, region, and educational level for some items in the survey (P-value ≤ 0.05). In the regression analysis, gender was the only variable statistically influenced the total Likert rating scores of the participants (r = -0.213, p-value = 0.013). Conclusion This study identified several barriers that exist in the nursing practice of EN in critical care settings. There are distinct differences in the perception of the nurses to these barriers based on their characteristics. Understanding such differences is important for implementing future strategies for units that needed the most help in prioritizing EN delivery.

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Enteral nutrition interruptions in critically ill patients: A prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay

Cited by 3 publications

References 17 publications

Cognitive influencing factors of ICU nurses on enteral nutrition interruption: a mixed methods study

Cognitive influencing factors of ICU nurses on enteral nutrition interruption: a mixed methods study

Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients

Understanding nursing perspective towards barriers to the optimal delivery of enteral nutrition in intensive care settings

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