Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Stewart, Melissa Lottes

doi:10.4037/ccn2014243

Cited by 41 publications

(50 citation statements)

References 69 publications

(81 reference statements)

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“…In a recent single‐center retrospective study of 100 enterally fed patients, the median duration of interruptions was 5.5 hours and resulted in an average calorie deficit of 11.5% . Stewart cites similar statistics with mean time of interruptions per patient >5 hours . In our project, feeding interruptions were reported on almost 1/3 of feeding days.…”

Section: Discussionsupporting

confidence: 65%

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Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

et al. 2019

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Background To meet protein needs in critical illness (CI), guidelines suggest ≥1.2–2.5 g protein/kg/d; however, most intensive care unit (ICU) patients receive ≤0.7 g/kg/d. Higher protein enteral nutrition (EN) formulas may be part of the solution to provide prescribed protein. Our objective was to demonstrate that an EN formula with 37% protein can deliver ≥80% of prescribed protein, without overfeeding calories within the first 5 days of feeding and to describe ICU clinicians' experience. Methods This quality improvement (QI) project included patients requiring exclusive EN for up to 5 days from 6 Canadian ICUs. Rationale for choosing formula, patient's BMI (kg/m2), nutrition targets, daily protein and energy delivered, feeding interruptions, and general tolerance were recorded. Results Forty‐four of 49 patients received the formula ≥2 days. Average protein prescribed was 137.5 g/d (82.5–200) or 1.9 g/kg/d (1.5–2.5). Average protein delivered was 116.9 g/d (33.5–180) or 1.6 g/kg/d (0.4–2.4). Seventy‐five percent to 83% of patients received ≥80% prescribed protein on days 2–5. Average energy prescribed was 1638.6 kcal/d (990–2500) or 17.8 kcal/kg (11–26). Average energy delivered was 1523.9 kcal/d (693.0–2557.5) or 17.3 kcal/kg/d (1.35–64.7). The formula was well tolerated with no gastrointestinal symptoms reported in 38 (86%) patients. The most common reasons to prescribe the formula were obesity and use of fat‐based medications. Conclusions We demonstrated in a QI study that a high‐protein EN formula was tolerated in a small, heterogeneous group of ICU patients and effective in meeting protein targets without overfeeding.

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Section: Discussionsupporting

confidence: 65%

“…Interruptions in enteral feeding occur frequently in the ICU and interfere with the delivery of prescribed nutrition . Common reasons for interruptions include cessation of EN for tests and procedures, technical issues with enteral access, and TFI.…”

Section: Discussionmentioning

confidence: 99%

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

et al. 2019

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“…Feeding interruptions in the ICU are also common and markedly affect nutritional adequacy. [13][14][15] Examples of common feeding interruptions include withholding feedings for surgical procedures or tests.…”

Section: Initiate Enteral Nutrition Earlymentioning

confidence: 99%

“…15,24 As a result, ICU patients receiving enteral nutrition may have significant caloric deficits. The problems associated with delivery of enteral nutrition in the ICU have been well described.…”

Section: Implement Enteral Feeding Protocolsmentioning

confidence: 99%

“…Barriers to nutritional adequacy for enterally fed patients include variation in physicians' practice, multiple interruptions, lack of knowledge, feeding tube issues, and gastrointestinal intolerance. 14,15 Enteral nutrition protocols have emerged in the past several years to address barriers in order to improve the adequacy of enteral nutrition delivery and improve outcomes for ICU patients. 25,26 Although it is difficult to provide 100% of goal calories by the enteral route, the implementation of nutrition protocols has shown promise in delivering a volume of enteral nutrition that more closely matches energy and protein requirements.…”

Section: Implement Enteral Feeding Protocolsmentioning

confidence: 99%

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Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition

O’Leary-Kelley

Bawel-Brinkley

2017

Critical Care Nurse

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NutritionIn critical care, malnutrition has a significant, negative impact on a patient's ability to respond to medical treatment. Enteral nutrition is known to counteract the metabolic changes associated with critical illness that increase the risk for serious complications and poor clinical outcomes. Inadequate delivery of nutrition support and underfeeding persist in intensive care units despite the availability of guidelines and current research for best practice. Recent studies have shown that nutrition support protocols are effective in promoting nutritional goals in a wide variety of intensive care patients. It is essential to find approaches that enhance early delivery of enteral nutrition that meets requirements and supports improved outcomes. Nurses are in a unique position to take an active role in promoting the best nutritional outcomes for their patients by using and evaluating nutrition support protocols. (Critical Care Nurse. 2017; 37[2]:e15-e23)Colleen O'Leary-Kelley, RN, PhD Karen Bawel-Brinkley, RN, PhD, CNE Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition C are of critically ill patients has become increasingly complex as a result of recent advances in technology and medicine. With this increasing complexity comes the potential for clinicians to lose sight of basic care issues such as nutritional management.1 Nutrition support has long been viewed as supportive therapy in critical care. However, with the expansion of current research revealing a more direct impact of nutrition support on patients' outcomes, nutrition is now viewed as having a more therapeutic role.2 Poor nutrition and negative energy balance combined with the catabolic stress and inflammation of acute illness and injury increase risk for complications. Complications may include increased length of stay, poor wound healing, aspiration, sepsis, and death. 3,4 In critical care, malnutrition has a significant, negative impact on a patient's ability to respond to medical treatment.5 Critical illness is associated with hypermetabolism and inflammation, which often lead to infection, organ dysfunction, and mortality. Nutrition intervention is known to counteract the metabolic changes associated with critical illness. 4 Many patients in intensive care units (ICUs) need mechanical ventilation and consequently require nutrition intervention to meet metabolic demands and supply their energy and protein needs. Current goals for nutrition support are focused on limiting catabolic response and systemic inflammation and promoting return to physiological baseline. 1 In critical illness, adequate intake of energy and protein is associated with improved clinical outcomes. As the philosophy around nutrition shifts from a supportive to a more therapeutic focus, the critical care team must use a coordinated approach to formulate decisions around nutrition support in order to provide adequate energy and protein, while avoiding the complications associated with nutrition support.1,3 Practice guidelines provide clinicians with t...

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Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study

de Abreu Silva,

de Vasconcelos Generoso,

da Rocha

et al. 2024

J Parenter Enteral Nutr

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ObjectiveThe present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support.MethodsA prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization.ResultsA total of 261 patients were evaluated, with a median age of 61.0 (49.0–69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass.ConclusionThere can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.

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Interruptions in Enteral Nutrition Delivery in Critically Ill Patients and Recommendations for Clinical Practice

Cited by 41 publications

References 69 publications

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

Nutrition Support Protocols: Enhancing Delivery of Enteral Nutrition

Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study

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