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. 2023 Feb 11;15(4):917.
doi: 10.3390/nu15040917.

Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients

Arezina N Kasti  1 , Maria Theodorakopoulou  2   3 , Konstantinos Katsas  1   4 , Kalliopi D Synodinou  1 , Maroulla D Nikolaki  1   5 , Alice Efstathia Zouridaki  1   6 , Stylianos Fotiou  1   7 , Aliki Kapetani  1 , Apostolos Armaganidis  3
Affiliations

Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients

Arezina N Kasti et al. Nutrients. .

Abstract

Background and aim: Feeding interruptions in critical care patients are often unjustified. We aimed to determine the causes, duration, and frequency of enteral nutrition interruptions (ENIs) and to assess macronutrients and antioxidant deficits according to European Society of Parenteral Enteral Nutrition (ESPEN) guidelines.

Methods: We prospectively enrolled Intensive Care Unit (ICU) patients admitted for more than 48 h with an inability to orally eat from April to December 2019. The type of enteral nutrition, the number of calories administered, the time of feeding initiation, the reasons for delaying feeding, and the causes for ENI were recorded.

Results: 81 patients were enrolled, with a median duration of ENIs of 5.2 (3.4-7.4) hours/day. Gastric residual volume (GRV) monitoring-a highly controversial practice-was the most common cause of ENI (median duration 3 (2.3-3) hours/day). The mean energy intake was 1037 ± 281 kcal/day, while 60.5% of patients covered less than 65% of the total energy needs (1751 ± 295 kcal/day, according to mean Body Mass Index (BMI)). The median daily protein intake did not exceed 0.43 ± 0.3 gr/kg/day of the actual body weight (BW), whereas ESPEN recommends 1.3 gr/kg/day for adjusted BW (p < 0.001). The average administration of micronutrients and antioxidants (arginine, selenium, zinc, vitamins) was significantly less than the dietary reference intake (p < 0.01).

Conclusion: ENIs lead to substantial caloric, protein, and antioxidant deficits.

Keywords: antioxidants; caloric deficit; intensive care; interruption of enteral nutrition; malnutrition; micronutrients.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Primary diagnosis at the time of ICU admission.
Figure 2
Figure 2
Frequency and average duration of ENIs for 5 days (3rd–7th day of ICU stay). Data are presented as numbers (%) and medians (IQR). Gastrointestinal dysfunctions included high GRV, diarrhea, and bowel ischemia. Other patient-related factors included pleural effusion and secretions. Other diagnostic procedures included body imaging techniques, such as CT scans, MRI, and abdominal ultrasounds (fasting for optimal visualization). The median duration of every ENI episode was calculated in the subsamples: interventional, diagnostic procedures, and patient-related factors (for instance, the median duration of ENIs due to diagnostic procedures was obtained from 45 patients).
Figure 3
Figure 3
Recommended micronutrient intake based on diagnosis [8,14,27,47].
See this image and copyright information in PMC

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References

    1. Zhang Z., Li Q., Jiang L., Xie B., Ji X., Lu J., Jiang R., Lei S., Mao S., Ying L., et al. Effectiveness of enteral feeding protocol on clinical outcomes in critically ill patients: A study protocol for before-and-after design. Ann. Transl. Med. 2016;4:308. doi: 10.21037/atm.2016.07.15. - DOI - PMC - PubMed
    1. Salciute-Simene E., Stasiunaitis R., Ambrasas E., Tutkus J., Milkevicius I., Sostakaite G., Klimasauskas A., Kekstas G. Impact of enteral nutrition interruptions on underfeeding in intensive care unit. Clin. Nutr. 2021;40:1310–1317. doi: 10.1016/j.clnu.2020.08.014. - DOI - PubMed
    1. Ndahimana D., Kim E.-K. Energy Requirements in Critically Ill Patients. Clin. Nutr. Res. 2018;7:81–90. doi: 10.7762/cnr.2018.7.2.81. - DOI - PMC - PubMed
    1. Powers J., Samaan K. Malnutrition in the ICU patient population. Crit. Care Nurs. Clin. N. Am. 2014;26:227–242. doi: 10.1016/j.ccell.2014.01.003. - DOI - PubMed
    1. Javid Z., Shadnoush M., Khadem-Rezaiyan M., Mohammad Zadeh Honarvar N., Sedaghat A., Hashemian S.M., Ardehali S.H., Nematy M., Pournik O., Beigmohammadi M.T., et al. Nutritional adequacy in critically ill patients: Result of PNSI study. Clin. Nutr. 2021;40:511–517. doi: 10.1016/j.clnu.2020.05.047. - DOI - PubMed

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