Investigating the prevalence, predictors and outcomes associated with enteral feeding intolerance in critically ill adults: a retrospective cohort study

Abstract

Background & aims: enteral feeding intolerance (EFI) is a common cause for failure to meet nutritional targets in critically ill patients. However, EFI is poorly defined, and prevalence varies according to the definition used. Predictors and outcomes associated with EFI have also been difficult to quantify due to the lack of a standardised definition. A recent systematic review proposed a definition of EFI as a failure to meet 80% of nutritional targets accompanied by one or more of the following gastrointestinal symptoms: vomiting/regurgitation, abdominal distention or diarrhoea. The aim of this study was to determine the prevalence of EFI in critically ill adults according to the definition proposed and: i) to examine associated predictors and ii) the impact on patients’ outcomes including intensive care unit (ICU) length of stay and mortality.

Methods: a single centre retrospective cohort study collected data on 400 patients admitted to a tertiary critical care unit in the UK. Data were collected on demographic variables, use of mechanical ventilation, medication, nutrition (calorie/protein targets; calories/protein received), nursed prone, gastrointestinal symptoms, intensive care length of stay, and 60-day mortality. Non-parametric tests and multivariable logistic regression were used to examine predictors of EFI and associations with ICU length of stay and 60-day mortality.

Results: 47.7% (n=191/400) of patients experienced at least one day of EFI. The median duration of intolerance was 1 day (range 1-21 days). Statistically significant predictors of EFI were fentanyl use (p<0.001), dexmedetomidine use (p=0.045) and hepato-pancreato-biliary disease (p=0.011). ICU length of stay was statistically significantly increased in patients with EFI compared to those without (p<0.001).

Conclusions: EFI is common in critically ill patients; however, for the majority, this intolerance is of short duration. Early identification and treatment strategies may reduce ICU length of stay, but further research is needed to investigate this.

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Identifiers

ORCID for M. Jamal Hossain: orcid.org/0000-0002-2728-1055

ORCID for Philip C. Calder: orcid.org/0000-0002-6038-710X

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