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American Journal of Critical Care. 2008;17: 53-61
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Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation

By Debra O’Meara, RN, Eduardo Mireles-Cabodevila, MD, Fran Frame, RN, A. Christine Hummell, RD, MS, CNSD, LD, Jeffrey Hammel, MS, Raed A. Dweik, MD and Alejandro C. Arroliga, MD. Debra O’Meara and Fran Frame are registered nurses in the Department of Nursing; Eduardo Mireles-Cabodevila and Raed A. Dweik are physicians in the Department of Pulmonary, Allergy, and Critical Care Medicine; A. Christine Hummell is a registered dietitian in the Department of Nutritional Therapy; and Jeffrey Hammel is a biostatistician in the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. Alejandro C. Arroliga is the director of the Department of Pulmonary and Critical Care Medicine at Scott and White Hospital and professor of medicine at Texas A&M College of Medicine in Temple, Texas.

Corresponding author: Eduardo Mireles-Cabodevila, MD, Department of Pulmonary, Allergy, and Critical Care; Cleveland Clinic, Cleveland, OH 44195 (e-mail: mirelee{at}ccf.org).

Background Published reports consistently describe incomplete delivery of prescribed enteral nutrition. Which specific step in the process delays or interferes with the administration of a full dose of nutrients is unclear.

Objectives To assess factors associated with interruptions in enteral nutrition in critically ill patients receiving mechanical ventilation.

Methods An observational prospective study of 59 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an 18-bed medical intensive care unit of an academic center. Data were collected prospectively on standardized forms. Steps involved in the feeding process from admission to discharge were recorded, each step was timed, and delivery of nutrition was quantified.

Results Patients received approximately 50% (mean, 1106.3; SD, 885.9 Cal) of the prescribed caloric needs. Enteral nutrition was interrupted 27.3% of the available time. A mean of 1.13 interruptions occurred per patient per day; enteral nutrition was interrupted a mean of 6 (SD, 0.9) hours per patient each day. Prolonged interruptions were mainly associated with problems related to small-bore feeding tubes (25.5%), increased residual volumes (13.3%), weaning (11.7%), and other reasons (22.8%). Placement and confirmation of placement of the small-bore feeding tube were significant causes of incomplete delivery of nutrients on the day of admission.

Conclusions Delivery of enteral nutrition in critically ill patients receiving mechanical ventilation is interrupted by practices embedded in the care of these patients. Evaluation of the process reveals areas to improve the delivery of enteral nutrition.


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