Evaluation of Patient's Energy Intake between Different Types of Formulas in the First Week of Starting Enteral Feeding in Intensive Care Unit Patients

Authors

1 Trauma Research Center, Shiraz University of Medical Science, Shiraz, Iran

2 Biochemistry and Nutrition Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Department of Nutrition, Shahid Trauma Center, Shiraz University of Medical Science, Shiraz, Iran

Abstract

Background: Adequate energy intake is an important factor in intensive care unit (ICU) patients, and it can decrease the patients' complications, length of hospitalization, mortality and health care costs. Choosing an appropriate type of formula may be effective in providing the sufficient energy for these patients. Objectives: This study aimed to assess the adequacy of energy intake, and to investigate the effect of different types of the formulas on the calorie intake and gastric residual volumes (GRV) in ICU patients in the first week of starting enteral feeding. Methods: This prospective observational study was conducted on 128 ICU patients of two hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The patients were randomly assigned to one of the four groups of formulas including Ensure, Entrameal standard, Nutricomp standard and Enterameal high fiber formulas. Energy intake and GRV were recorded daily for 7 consecutive days from the beginning of enteral feeding. Results: About 85% of the patients had traumatic brain injury. The average calculated energy requirement of the patients was 2293 kcal while the average energy intakes in seven days, and on the last day were 668 and 977 kcal, respectively. Only two patients (1.5%) received nearly all their energy requirement in the last day, however, only 5.5% and 35% of the subjects received ≥ 60% and ≥ 80% of their energy requirement, respectively. Enterameal high fiber formula was associated with a significant increase in GRV compared to Ensure formula (p = 0.02), but no significant relationship was found between calorie intake and gastrointestinal symptoms. No statistically significant difference was found in the energy intake between the four types of formulas. Conclusion: It seems that enteral feeding in our ICUs is not successful in practice using the common available formulas. More attention should be paid to the incomplete delivery of the prescribed enteral nutrition in ICU patients.

Keywords

References

  1. 1.Thibault R, Pichard C. Nutrition and clinical outcome in intensive care patients. Curr Opin Clin Nutr Metab Care. 2010;13(2):177-83. doi: 10.1097/MCO.0b013e32833574b9. [PubMed: 19996743].

    1. Krishnan JA, Parce PB, Martinez A, Diette GB, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest. 2003;124(1):297-305. [PubMed: 12853537].
    2. Patel JJ, Hurt RT, McClave SA, Martindale RG. Critical care nutrition: where’s the evidence? Crit Care Clin. 2017;33(2):397- 412. doi: 10.1016/j.ccc.2016.12.006. [PubMed: 28284302].
    3. Khan I, Bojedla S, Badjatia N. Nutritional support in the Neurointensive Care Unit. Nutr Neurol Disord. 2017;5:77-90. doi: 10.1007/978-3-319-53171-7_5.
    4. Jones KJ, Maxwell PJ, McClave S, Allen K. Optimizing enteral nutrition in medical intensive care patients. Curr Pulmonol Rep. 2017;6(1):64-9. doi: 10.1007/s13665-017-0169-9.
    5. Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux RNM, Delarue J, et al. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients. Clin Nutr. 2005;24(4):502-9. doi: 10.1016/j.clnu.2005.03.006. [PubMed: 15899538].
    6. Peev MP, Yeh DD, Quraishi SA, Osler P, Chang Y, Gillis E, et al. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2015;39(1):21-7. doi: 10.1177/0148607114526887. [PubMed: 24714361].
    7. De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Crit Care Med. 2001;29(1):8-12. [PubMed: 11176150].
    8. Kim H, Stotts NA, Froelicher ES, Engler MM, Porter C. Why patients in critical care do not receive adequate enteral nutrition? A review of the literature. J Crit Care. 2012; 27(6):702-13. doi: 10.1016/j.jcrc.2012.07.019. [PubMed: 23084129].
    9. O'Meara D, Mireles-Cabodevila E, Frame F, Hummell AC, Hammel J, Dweik RA, et al. Evaluation of delivery of enteral nutrition in critically ill patients receiving mechanical ventilation. Am J Crit Care. 2008;17(1):53-61. [PubMed: 18158390].
    10. Metheny NA. Residual volume measurement should be retained in enteral feeding protocols. Am J Crit Care. 2008; 17(1):62-4. [PubMed: 18158391].
    11. Chen Y, Peterson SJ. Enteral nutrition formulas: which formula is right for your adult patient? Nutr Clin Pract. 2009;24(3):344-55. doi: 10.1177/0884533609335377. [PubMed: 19483064].
    12. Tiengou LE, Gloro R, Pouzoulet J, Bouhier K, Read MH, ArnaudBattandier F, et al. Semi-elemental formula or polymeric formula: is there a better choice for enteral nutrition in acute pancreatitis? Randomized comparative study. JPEN J Parenter Enteral Nutr. 2006;30(1):1-5. doi: 10.1177/014860710603000101. [PubMed: 16387891].
    13. Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med. 2001;29(10):1955-61. [PubMed: 11588461].
    14. Lavrentieva A, Kontakiotis T, Bitzani M. Enteral nutrition intolerance in critically ill septic burn patients. J Burn Care Res. 2014;35(4):313-8. [PubMed: 24879397].
    15. Mahan LK, Escott-Stump S, Krause MV. Krause's food & nutrition therapy. 14th ed. New York, US: Elsevier Saunders; 2016. P. 387-402.
    16. Kim H, Stotts NA, Froelicher ES, Engler MM, Porter C. Enteral nutritional intake in adult korean intensive care patients. Am J Crit Care. 2013;22(2):126-35. doi: 10.4037/ajcc2013629. [PubMed: 23455862].
    17. Kim H, Shin JA, Shin JY, Cho OM. Adequacy of nutritional support and reasons for underfeeding in neurosurgical intensive care unit patients. Asian Nurs Res. 2010;4(2):102-10. doi: 10.1016/S1976-1317(10)60010-2. [PubMed: 25030950].
    18. Kim H, Stotts NA, Froelicher ES, Engler MM, Porter C, Kwak H. Adequacy of early enteral nutrition in adult patients in the intensive care unit. J Clin Nurs. 2012;21(19-20):2860-9. doi: 10.1111/j.1365-2702.2012.04218.x. [PubMed: 22845617].
    19. Heidegger CP, Romand JA, Treggiari MM, Pichard C. Is it now time to promote mixed enteral and parenteral nutrition for the critically ill patient? Intensive Care Med. 2007;33(6):963-9. doi: 10.1007/s00134-007-0654-7. [PubMed: 17468845].
    20. Gunst J, Van den Berghe G. Parenteral nutrition in the critically ill. Curr Opin Crit Care. 2017;23(2):149-58. doi: 10.1097/MCC.0000000000000385.
    21. Scaife CL, Saffle JR, Morris SE. Intestinal obstruction secondary to enteral feedings in burn trauma patients. J Trauma. 1999;47(5):859-63. [PubMed: 10568712].
Razavi International Journal of Medicine
Volume 6, Issue 3
Summer 2018

Files

Share

How to cite

Statistics