A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK

Abstract

Objectives: To describe the incidence of problems associated with enteral feeding in different patient groups and intensive care units (ICUs). To compare this incidence with specific feeding protocols and volumes of feed delivered. To identify for future study any interventions likely to improve delivery of enteral feed and to manage or eliminate problems.

Design: A prospective, descriptive study of problems associated with enteral feeding in five ICUs over a period of 9 months.

Setting: ICUs in two district general and three university hospitals.

Patients: ICU patients (age > 18 years) who received enteral feeding for a period > 24 h.

Measurements and results: 193 patients were studied for a total of 1929 patient-days. On average, only 76% of the quantity of feed prescribed was delivered to the patient. The two main problems preventing delivery of feed were gut dysfunction and elective stoppage for procedures. ICUs with well-defined feeding protocols delivered significantly greater volumes of feed (p < 0.0001) than those without. Feeding was abandoned in 11% of patients, half of these due to gastric dysfunction. Only 2 of 193 patients were fed jejunally.

Conclusions: The major factors associated with the interruption in delivery of feed are problems with gut function and stopping feed prior to a procedure. Use of specific feeding protocols is clearly associated with a greater volume of feed delivered and a greater percentage of the prescription delivered. These should be an integral part of all ICU protocols.