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Learning Objective 1: describe the need and direction for future research to establish evidence of reliability and validity in the assessment of enteral nutrition intolerance.
Learning Objective 2: describe the variation in definitions and manifestations of enteral nutrition intolerance and how these variations may influence enteral nutrition and patient care delivery.
There is no consensus on the definition of intolerance to enteral nutrition (EN), the constellation of signs and symptoms that should be assessed to indicate intolerance, and no assessment tools used in practice to measure EN intolerance. Tolerance is influenced by gastrointestinal (GI) tract function. Clinical manifestations of GI impairment that may contribute to EN intolerance include nausea, vomiting, diarrhea, constipation and abdominal distension.
Purpose
The purpose of this study was to determine the feasibility of using a new researcher-developed assessment tool, the Severity of Gastrointestinal Impairment (SOGI) to better define EN intolerance and assess the severity of GI impairment in patients undergoing mechanical ventilation and receiving EN in the critical care setting.
Methods
A descriptive exploratory design was used to assess the feasibility of using the SOGI in clinical practice using four critical care nurses who assessed up to three critical care patients each across the first 3 days of EN. The nurses were interviewed regarding the ease of use and pertinence of the SOGI.
Results
None of the patients assessed with the SOGI experienced significant GI impairment. Constipation was the most frequent finding, and variation in the definition of diarrhea among the nurses was noted. Of those patients assessed with the SOGI (N=11), there was one documented elevation in gastric residual volume (< 250 mL over the last 24 hours), as well as one report of diarrhea (the patient had experienced 4 or more liquid stools in the prior 24 hours) and constipation was reported 3 times. Of those who experienced constipation, one had not passed stool in 4-5 days and two individuals had gone > 5 days without passing stool. There was insufficient data to perform psychometric testing.
Implications
Each of the components in the SOGI should be independently studied for evidence of reliability and validity.