Prevalence and Risk Factors of Enteral Feeding Intolerance in Critically Ill Patients and the Effectiveness of Preventive Treatments: A Prospective Study

Yajuan Xiao; Lei Xu

doi:10.4103/sjmms.sjmms_384_22

Prevalence and Risk Factors of Enteral Feeding Intolerance in Critically Ill Patients and the Effectiveness of Preventive Treatments: A Prospective Study

Saudi J Med Med Sci. 2023 Apr-Jun;11(2):135-142. doi: 10.4103/sjmms.sjmms_384_22. Epub 2023 Apr 12.

Authors

Yajuan Xiao¹, Lei Xu²

Affiliations

¹ School of Smart Healthcare Industry, Chongqing City Management College, No. 151, South 2 Road, University Town, Gao Xin District, Chongqing 401331, China.
² Anesthesia and Operating Room, The 940 Hospital of Joint Logistic Support Force of Chinese People's Liberation Army, No. 333 Nan Bing He Street, Qi Li He District, Lan Zhou 730000, China.

Abstract

Background: Feeding intolerance (FI) is a prevalent cause of enteral nutrition (EN) disruption. Factors that can prevent FI are poorly described.

Objectives: To determine the prevalence and risk factors associated with FI in critically ill patients and the effectiveness of preventive treatments.

Patients and methods: This prospective observational study included critically ill patients admitted to the ICU of a general hospital who received EN through a nasogastric or nasointestinal tube from March 2020 to October 2021. Independent sample t-test, repeated measurement analysis of variance, and multivariate analysis were used to explore independent risk factors and the efficacy of preventive treatments.

Results: The study included 200 critically ill patients (mean age: 59.1 ± 17.8 years), of whom 131 were male. Most patients (58.50%) developed FI after a median EN duration of 2 days. The independent risk factors for FI were fasting for >3 days, high APACHE II score, and acute gastrointestinal injury (AGI) grade I before EN (P < 0.05). During EN, whole protein was found to be an independent preventive treatment that significantly decreased FI (P < 0.05), while before EN, early use of enema and gastric motility drugs in patients with abdominal distention/constipation significantly decreased FI (for both, P < 0.05). The preventive treatment group had significantly higher intake of the nutrient solution and significantly shorter invasive mechanical ventilation duration than the without preventive treatment group (for both, P < 0.05).

Conclusion: In ICU patients receiving nasogastric or nasointestinal tube feeding, FI was frequent, occurred early, and was more frequent in patients with fasting >3 days, a high APACHE II score, and an AGI grade before EN. Preventive treatments can reduce FI prevalence and result in patients consuming more nutrient solutions and having shorter invasive mechanical ventilation duration.

Chinese clinical trial registry registration no: ChiCTR-DOD-16008532.

Keywords: APACHE II; critical care; effect factors; enteral feeding intolerance; enteral nutrition; preventive treatments.