The prevalence and possible causes of enteral tube feeding intolerance in critically ill patients: A cross-sectional study

Clinical practice guidelines for nutritional assessment and monitoring of adult ICU patients in China

The Chinese Society of Critical Care Medicine (CSCCM) has developed clinical practice guidelines for nutrition assessment and monitoring for patients in adult intensive care units (ICUs) in China. This guideline focuses on nutrition evaluation and metabolic monitoring to achieve optimal and personalized nutrition therapy for critically ill patients. This guideline was developed by experts in critical care medicine and evidence-based medicine methodology and was developed after a thorough review of the system and a summary of relevant trials or studies published from 2000 to July 2023. A total of 18 recommendations were formed and consensus was reached through discussions and reviews by expert groups in critical care medicine, parenteral and enteral nutrition, and surgery. The recommendations are based on currently available evidence and cover several key fields, including screening and assessment, evaluation and assessment of enteral feeding intolerance, metabolic and nutritional measurement and monitoring during nutrition therapy, and organ function evaluation related to nutrition supply. Each question was analyzed according to the Population, Intervention, Comparison, and Outcome (PICO) principle. In addition, interpretations were provided for four questions that did not reach a consensus but may have potential clinical and research value. The plan is to update this nutrition assessment and monitoring guideline using the international guideline update method within 3-5 years.

Effect of timing of enteral nutrition initiation on poor prognosis in patients after cardiopulmonary bypass: A prospective observational study

OBJECTIVES

Current guidelines recommend that enteral nutrition (EN) be implemented as early as possible in patients after cardiopulmonary bypass (CPB), but the optimal time to initiate EN remains controversial. Therefore, the aim of this study was to investigate the effect of timing of EN initiation on poor prognosis in patients after CPB.

METHODS

This was a prospective observational study with patients who underwent CPB in a tertiary hospital from September 1, 2021, to January 31, 2022. The patients were divided into three groups according to the timing of EN initiation: <24 h, 24 to 48 h, and >48 h. Unconditional logistic regression was used to calculate odds ratios (OR) and 95% confidence intervals to identify independent risk factors for poor prognosis.

RESULTS

The study included 579 patients, of whom 255 patients had EN initiated at <24 h (44%), 226 at 24 to 48 h (39%), and at >48 h (17%). With EN <24 h as a reference, multivariate logistic analysis showed that EN 24 to 48 h (OR, 1.854, P = 0.008) and EN >48 h (OR, 7.486, P <0.001) were independent risk factors for poor prognosis after CPB. Age (OR, 1.032, P = 0.001), emergency surgery (OR, 10.051; P <0.001), surgical time (OR, 1.006; P <0.001), and sequential organ failure assessment score (OR, 1.269; P = 0.001) also increased the risk for poor prognosis after CPB.

CONCLUSIONS

Compared with early EN <24 h, EN 24 to 48 h and EN >48 h increased the risk for poor prognosis in patients after CPB.

Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis

BACKGROUND

A unified clinical definition of feeding intolerance (FI) is urged for better management of enteral nutrition (EN) in critically ill patients. We aimed to identify optimum clinical FI definitions based on reported evidence.

METHODS

We searched clinical studies comparing FI with non-FI with a clear definition, summarized the evidence by random-effect meta-analyses, and rated the certainty of evidence by the Grading of Recommendations Assessment, Development and Evaluation frameworks.

RESULTS

Five thousand five hundred twenty-five records were identified, of which 26 eligible studies enrolled 25,189 adult patients. Most patient-centered outcomes were associated with FI overall. Low to very low certainty evidence established FI defined as large gastric residual volume (GRV) ≥ 250 ± 50 mL combined with any other gastrointestinal symptoms (GIS) had a significant association with high mortalities in particular all-cause hospital mortality (odds ratio [OR] 1.90, 95% confidence interval [CI] 1.40-2.57), the incidence of pneumonia (OR 1.54, 95% CI 1.13-2.09) and prolonged length of hospital stay (mean difference 4.20, 95% CI 2.08-6.32), with a moderate hospital prevalence (41.49%, 95% CI 31.61-51.38%). 3-day enteral feeding (EF) delivered percentage < 80% had a moderate hospital prevalence (38.23%, 95% CI 24.88-51.58) but a marginally significant association with all-cause hospital mortality (OR 1.90, 95% CI 1.03-3.50).

CONCLUSIONS

In critically ill adult patients receiving EN, the large-GRV-centered GIS to define FI seemed to be superior to 3-day EF-insufficiency in terms of both close associations with all-cause hospital mortality and acceptable hospital prevalence (Registered PROSPERO: CRD42022326273).

TRIAL REGISTRATION

The protocol for this review and meta-analysis was registered with PROSPERO: CRD42022326273. Registered 10 May 2022.

Effects of dietary fibre on enteral feeding intolerance and clinical outcomes in critically ill patients: A meta-analysis

BACKGROUND

Although some studies have explored the relationships between dietary fibre and enteral feeding intolerance in critically ill patients, the results are equivocal.

OBJECTIVE

This study aimed to explore the effects of dietary fibre on enteral feeding intolerance and clinical outcomes in critically ill patients.

METHODS

We searched five databases from inception to July 12, 2021. Data were expressed as mean difference or odds ratio with 95% confidence interval.

RESULTS

Thirteen studies enrolled 709 critically ill patients included in the study. The results showed the dietary fibre group had a significantly decreased risk of diarrhea (OR: 0.46, 95% CI: 0.30,0.69, P < 0.001), regurgitation (OR: 0.28, 95%CI: 0.13, 0.60, P < 0.05), vomiting (OR: 0.40, 95%CI: 0.17, 0.92, P < 0.05), constipation (OR: 0.21, 95%CI: 0.09, 0.47, P < 0.001) and mortality (OR:0.34; 95%CI:-0.13, 0.91; P < 0.05) compared with the fibre free group. Besides, there was a significant decrease on time to reach full enteral nutrition (MD:-2.08; 95%CI:-4.05, -0.12; P < 0.05), the duration of the intensive care unit stay (MD:-4.62; 95%CI:-6.60, -2.64; P < 0.001) and hospital stay (MD:-6.42; 95%CI:-9.49, -3.36; P < 0.001) in the dietary fibre group.

CONCLUSIONS

Dietary fibre supplementation may significantly reduce the risk of enteral feeding intolerance and improve the clinical outcomes.

Related Factor Analysis and Nursing Strategies of Diarrhea in Critically Ill Patients with Enteral Nutrition

Objective. To explore the related factors of diarrhea in critically ill patients with enteral nutrition (EN) in the intensive care unit (ICU). Methods. This single-center retrospective study analyzed the occurrence of intolerant diarrhea in ICU patients receiving EN treatment in our hospital. By collecting clinical data, univariate and multivariate logistic regression analysis was used to screen the risk factors for diarrhea. Results. Among 120 patients included in the study, 68 (48.33%) had diarrhea. Age (OR = 2.599, $P=0.027$ ), use of antibiotics (OR = 3.496, $P=0.007$ ), ICU hospitalization time (OR = 1.311, $P=0.001$ ), and mechanical ventilation time (OR = 1.273, $P=0.035$ ) were all independent risk factors for diarrhea in EN. Conclusion. Older age, frequent use of antibiotics, long ICU stay, and mechanical ventilation time can lead to diarrhea in ICU patients receiving EN treatment. It is necessary to effectively analyze the above independent factors and implement targeted interventions to improve the incidence of diarrhea in patients.