Adequacy of Early Enteral Feeding in Adult Korean Intensive Care Unit Patients

Kim, Hyunjung

Friday, July 15, 2011: 3:45 PM

Hyunjung Kim, RN, MSN¹
Nancy A. Stotts, RN, EdD, FAAN¹
Erika S. Froelicher, RN, PhD, FAAN¹
Marguerite M. Engler, PhD, RN, FAHA¹
Carol Porter, PhD, RD, FADA²
(1)Physiological Nursing, UCSF, San Francisco, CA
(2)Department of Pediatrics, UCSF, San Francisco, CA

Learning Objective 1: Participants will be able to describe the experience of insufficient delivery of enteral feeding in ICU patients

Learning Objective 2: Participants will be able to operationalize their knowledge to help increase energy intake by enteral feeding in ICU patients

Background & Aims: Insufficient delivery of enteral nutrition is a common problem for patients in the intensive care unit (ICU). Underfeeding is associated with severe negative consequences including increased morbidity and mortality. The aims of this study were to evaluate the adequacy of energy intake in enteral feeding of patients in the Korean ICU in the first four days after initiation of enteral feeding and to investigate the reasons for and duration of interruptions in feeding.

Methods: A prospective, cohort study of 34 consecutive patients receiving bolus enteral nutrition was conducted in a Korean medical ICU. The amount of energy prescribed and delivered was recorded for four consecutive days. Energy requirements were calculated using the Harris-Benedict equation. The reasons for and duration of interruptions in enteral feeding were recorded daily. Data analysis included descriptive and inferential statistics.

Results: Significantly less energy was delivered enterally than was prescribed (t=5.567, p<.001). On average, 89% of the mean energy requirement was prescribed and 89% of the prescribed energy was delivered. Patients received 80% of their energy requirements by enteral feeding. Most patients (68%) were underfed, although some (29%) were adequately fed. Most patients (79%) experienced enteral feeding interruptions. The mean length of interruptions was 90 minutes per patient each day. Most interruptions were due to gastrointestinal intolerance (30%); airway management (22%); and procedures or tests (18%).

Conclusion: Under-prescription of enteral nutrition combined with insufficient delivery of the prescribed nutrition resulted in inadequate nutritional intake in most bolus fed patients in the Korean ICU. The most frequent interruptions in enteral feeding delivery were due to gastrointestinal intolerance. Study data point to the need to maximize delivery of prescribed feeding to mitigate inadequate intake. Future research is needed to develop and test enteral feeding protocols to provide adequate nutritional support to this Korean ICU population.

See more of: Competencies in Adult Health Care
See more of: World Academy of Nursing Science: Oral Paper & Posters