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American Journal of Critical Care. 2004;13: 221-227
Copyright © 2004 by the American Association of Critical-Care Nurses.
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OUTCOMES ASSOCIATED WITH ENTERAL TUBE FEEDINGS IN A MEDICAL INTENSIVE CARE UNIT

By Ellen H. Elpern, RN, MSN, CCNS, Luminita Stutz, RN, MS, BS, Sarah Peterson, MS, RD, CNSD, David P. Gurka, MD, PhD and Annalynn Skipper, MS, RD, CNSD. From the Departments of Critical Care Medicine (EHE, DPG), Adult Critical Care Nursing (EHE, LS), and Food and Nutrition (SP, AS), Rush University Medical Center, Chicago, Ill.

• Background Underfeeding of patients reliant on enteral tube feedings most likely is due primarily to interruptions in the infusions. Strategies to improve energy intake require an understanding of such interruptions and associated outcomes.

• Objectives To compare daily energy intake with goal energy intake; to ascertain frequency, duration, and reasons for interruptions in feedings; and to determine occurrences of feeding intolerance.

• Methods A prospective, descriptive study of a convenience sample of patients admitted during a 3-month period to a medical intensive care unit. Patients were included who were expected to receive continuous enteral tube feedings for at least 48 hours. Patients were studied until discontinuation of feedings, discharge from the unit, or death.

• Results Thirty-nine patients were studied for 276 feeding days. Patients received a mean of 64% of goal energy intake. Mean length of interruptions in feeding was 5.23 hours per patient per day. Interruptions for performance of tests and procedures accounted for 35.7% of the total cessation in feeding time. Next most time-consuming interruptions occurred with changes in body position (15%), unstable clinical conditions (13.5%), high gastric residual volume (11.5%), and nausea and vomiting (9.2%). Patients had diarrhea 105 (38%) of 276 feeding days. Gastric residual volumes exceeded 150 mL on 28 measurements in 11 patients. Five patients experienced episodes of nausea and vomiting. Four patients experienced an episode of feeding aspiration.

• Conclusions Precautionary interruptions in enteral feedings to decrease presumed risk of aspiration occurred frequently and resulted in underfeeding. Episodes of vomiting and of aspiration were uncommon.




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