Risks in Management of Enteral Nutrition in Intensive Care Units: A Literature Review and Narrative Synthesis

Abstract

Critically ill patients in the intensive care unit (ICU) have a high risk of developing malnutrition, and this is associated with poorer clinical outcomes. In clinical practice, nutrition, including enteral nutrition (EN), is often not prioritized. Resulting from this, risks and safety issues for patients and healthcare professionals can emerge. The aim of this literature review, inspired by the Rapid Review Guidebook by Dobbins, 2017, was to identify risks and safety issues for patient safety in the management of EN in critically ill patients in the ICU. Three databases were used to identify studies between 2009 and 2020. We assessed 3495 studies for eligibility and included 62 in our narrative synthesis. Several risks and problems were identified: No use of clinical assessment or screening nutrition assessment, inadequate tube management, missing energy target, missing a nutritionist, bad hygiene and handling, wrong time management and speed, nutritional interruptions, wrong body position, gastrointestinal complication and infections, missing or not using guidelines, understaffing, and lack of education. Raising awareness of these risks is a central aspect in patient safety in ICU. Clinical experts can use a checklist with 12 identified top risks and the recommendations drawn up to carry out their own risk analysis in clinical practice.

Healthcare Resource Utilization and Cost Comparisons of High-Protein Enteral Nutrition Formulas Used in Critically Ill Patients

“…16,24 In the ICU, appropriate nutrition management is vital to avoid potential risks. 25 Given the characteristics and comorbid conditions of our real-world sample, proper choice of high-protein EN is essential.…”

Importance of nutritional assessment tools in the critically ill patient: A systematic review

“…However, in clinical practice, despite the recommendations of scientific organizations such as the American Society for Parenteral and Enteral Nutrition (ASPEN), nutritional assessment on admission is not a standardized parameter ( 1 ). Moreover, tools such as the “Mini Nutritional Assessment” (MNA) are often used, which have not been designed for use in this type of patient, and may therefore lead to underestimation of risk ( 1 , 2 ).…”

“…Importance of nutritional assessment tools in the critically ill patient: A systematic review 1. Introduction In intensive care units (ICU), critically ill patients are at high risk of developing malnutrition, which is associated with worse clinical outcome (1). The nutritional status of critically ill patients deteriorates quite rapidly after admission, as a consequence of severe catabolism caused by stress, proinflammatory cytokines, and hormones, even when patients are well nourished.…”

Effects of enteral nutrition with different energy supplies on metabolic changes and organ damage in burned rats

“…Enteral nutrition (EN), one of the main nutritional support methods for severe burn patients, has attracted considerable attention because of its unique advantages in maintaining the intestinal mucosal barrier. However, burn victims exhibit extensive gastrointestinal congestion, edema and motor dysfunction, which limit the application of EN [ 6–8 ]. Trophic EN, which aims to moderately stimulate the gastrointestinal mucosa rather than supply energy, provides a basic solution to this dilemma.…”