Feeding intolerance score in critically ill patients with enteral nutrition: A post hoc analysis of a prospective study

Abstract

Background: Feeding intolerance (FI) is common in critically ill patients fed with enteral nutrition. Although there is increasing evidence showing the association between FI and mortality, no reliable quantitative assessment was available in clinical practice. In this study, we proposed a FI scoring system based on gastrointestinal (GI) symptoms to assist the implementation of enteral nutrition and assessed its association with 28-day mortality.Methods: This is a post hoc analysis based on data collected in a previous crosssectional study. All adult patients who were enterally fed were included. Various definitions of FI were compared. The area under the receiver operating characteristic (AUROC) was used to assess the predictive performance for 28-day mortality. Pearson correlation coefficient and the variance inflation factor were applied to detect collinearity among variables. Multiple logistic regression analysis was used to determine the risk factors for 28-day mortality.Results: Of the 1098 patients included, 200 (18.2%) were nonsurvivors. The incidence of GI symptoms was higher in nonsurvivors on the study day. The multiple logistic regression analysis showed that the proposed FI score was an independent risk factor for 28-day mortality (odds ratio [OR]: 1.37; 95% CI, 1.25-1.51; P < .001). Moreover, the FI score showed better predictive accuracy for 28-day mortality than the other definitions (AUROC: 0.633 [95% CI, 0.591-0.675] for the FI score vs 0.595 (95% CI, 0.557-0.633] for the best-performing FI definition [P = 0.001]).Conclusions: FI score is independently associated with 28-day mortality in critically ill patients with acceptable predictive accuracy.

Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial

“…Feeding intolerance is a significant concern impeding the early achievement of energy targets worldwide [16]. Our feeding guideline incorporated a self-developed feeding intolerance score for repeated gastrointestinal function assessment [17]. The feeding intolerance score includes key gastrointestinal symptoms and intra-abdominal pressure, both associated with ICU mortality [18,19], and we categorized them into four grades of severity for quantitive measurement.…”

Best evidence summary for prevention and management of enteral feeding intolerance in critically ill patients

“…One large cohort study was included (Lin et al., 2022). Table 5 contains the quality evaluation results of this cohort study.…”

“…Further reading of the full text and removal of 381 articles that did not meet the inclusion criteria of this study resulted in 18 articles included in the final analysis (Figure 2). These 18 articles comprised two clinical decisions (Heuschkel, 2023; Seres, 2023), five guidelines (Compher et al., 2022; Hua et al., 2023; Reintam Blaser et al., 2017; Singer et al., 2019; Ukleja et al., 2018), three expert consensus (Chinese Abdominal Intensive Care Association, 2021; Guoqiang et al., 2022; Yuanyuan et al., 2021), six systematic reviews (Kokura et al., 2020; Kristine Koekkoek et al., 2019; Lee et al., 2023; Liu et al., 2023; Wang et al., 2022, 2019), a summary of evidence (Odhiambo, 2022) and one large cohort study (Lin et al., 2022). The literature screening process is shown in Figure 2.…”

“…Lin et al. (Lin et al., 2022) conducted a multicentre cluster randomized controlled trial on feeding processes and proposed a feeding intolerance scoring system based on gastrointestinal symptoms to assist the implementation of enteral nutrition. Use of this feeding intolerance score may facilitate the timely treatment of feeding intolerance during the implementation of enteral nutrition, thereby improving nutrition therapy in critically ill patients.…”

Role of gastric ultrasound to guide enteral nutrition in the critically ill

“…Gastrointestinal dysfunction has accumulating evidence of a negative impact on outcomes. However, despite several efforts to integrate gastrointestinal function into scores or the development of monitoring instruments for these settings, nothing appeared to integrate the complexity of the gastrointestinal tract [16][17][18][19]. A 'one size fits all' principle is not an optimal solution in the clinical practice of enteral nutrition in critically ill patients because of the considerable heterogeneity of the ICU population and the many risk factors for gastrointestinal dysfunction [15].…”