Enteral nutritional intake in adult korean intensivecare patients

Abstract

Background Nutritional support is important for maximizing clinical outcomes in critically ill patients, but enteral nutritional intake is often inadequate. Objectives To assess the nutritional intake of energy and protein during the first 4 days after initiation of enteral feeding and to examine the relationship between intake and interruptions of enteral feeding in Korean patients in intensive care. Methods A cohort of 34 critically ill adults who had a primary medical diagnosis and received bolus enteral feeding were studied prospectively. Energy and protein requirements were determined by using the Harris-Benedict equation and the American Dietetic Association equation. Energy and protein intake prescribed and received and the reasons for and lengths of feeding interruptions were recorded for 4 consecutive days immediately after enteral feeding began. Results Although the differences between requirements and intakes of energy and protein decreased significantly, patients did not receive required energy and protein intake during the 4 days of the study. Energy intake prescribed was consistently less than required on each of the 4 days. Enteral nutrition was withheld for a mean of 6 hours per patient for the 4 days. Prolonged feeding interruptions due to gastrointestinal intolerance (r = −0.874; P < .001) and procedures (r = −0.839; P = .005) were negatively associated with the percentage of prescribed energy received. Conclusion Enteral nutritional intake was insufficient in bolus-fed Korean intensive care patients because of prolonged feeding interruptions and underprescription of enteral nutrition. Feeding interruptions due to gastrointestinal intolerance and procedures were the main contributors to inadequate energy intake.

Enteral Nutrition in the Prevention and Treatment of Pressure Ulcers in Adult Critical Care Patients

“…Prolonged periods of no oral intake related to procedures, unstable hemodynamic status, administration of medications, and cessation of enteral feeding because of perceived gastrointestinal complications such as high gastric residual volumes (GRVs) and diarrhea can also result in underfeeding. 40 In 2 studies 41,42 in critical care patients, the mean length of feeding interruptions was 6 h/d. Common causes of interruptions in these studies included problems with small-bore feeding tubes, increases in GRV or feeding intolerance, weaning, shock states, and interruptions related to procedures or routine patient care, such as bathing, repositioning, and skin care.…”

“…For patients receiving enteral feedings, the guidelines state that the amount of time feedings are withheld may need to be modified on the basis of the clinical judgment of the practitioner. In a recent study 42 Hydration in addition to food requirements plays a vital role in the maintenance and repair of skin integrity.…”

Insights and Advances in Multidisciplinary Critical Care: A Review of Recent Research

“…57 Indeed, nutritional intake in critically ill patients is often inadequate because of unnecessary prolonged feeding interruptions or prescriptions insufficiently covering daily requirements. 58 Nurse empowerment could be the way forward to deal with insufficient calorie intake. A condition for such an approach, however, is sufficient staffing, as fewer nursing professionals per bed in itself appears to a risk factor for inadequate nutritional intake.…”

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“…(19) Apesar das evidências e de especialistas ressaltarem a importância do início de TN no prazo de 24 horas a 48 horas de admissão em UTI, na prática clínica é diferente. Estudos relatam que 40 a 60% dos pacientes que são elegíveis para o início de TNE ainda não recebem alimentação dentro de 48 horas de admissão na UTI (19) ; outro estudo traz a média de 5,3 dias após a internação na UTI para início da TNE (20) , porém é importante ressaltar que não existe uma patologia conhecida que se beneficie de jejum prolongado. O tempo médio de 24 horas pode ser atribuído ao protocolo institucional de passagem da sonda juntamente com a intubação dos pacientes, permitindo o início da TNE assim que o paciente apresenta condições hemodinâmicas.…”

“…Hyunjung Kim et al também destacaram que a consciência e o conhecimento dos profissionais de saúde sobre a terapia nutricional em cuidados intensivos devem ser aumentados para melhorar o suporte nutricional de pacientes criticamente enfermos. (20) É comum a terapia nutricional estar sob cuidados de profissionais com outras funções de também grande importância na unidade, o que pode levar à ausência de atenção específica para esta área, tanto pelo prescritor, quanto pela equipe de enfermagem. Em estudo realizado no Hospital Universitário de Lausanne, Suíça, os autores mostraram que a soma de uma implantação de protoloco nutricional de atuação multidisciplinar com a presença de um profissional nutricionista em tempo integral na rotina da Unidade de Terapia Intensiva trouxe um aumento de 31,6% da entrega calórica, redução do déficit energético, introdução precoce da terapia nutricional, evidenciando maior recuperação dos pacientes da UTI em questão.…”