EXPERIENCE WITH ENTERAL NUTRITION IN A HOSPITAL POPULATION OF ACUTELYILL PATIENTS

Enteral feeding has unique metabolic and immune advantages, This artic le describes the successful use of enteral nutrition, alone or in comb ination with parenteral feeding, in a tertiary-care hospital. Study pa rticipants were 89 patients who received enteral feeding during a 6-mo nth period. These critically ill patients (ranging in age from 55 to 7 1 years) had severity of illness levels of 7 to 25 according to the Ac ute Physiologic and Chronic Health Evaluation (APACHE II) system and l engths of hospital stay from 27 to 73 days. Mortality was as high as 5 0% in patients with liver disease (nonmalignant), 35% in patients with cardiothoracic and vascular diseases, and 17% in patients with cancer and other diseases. Despite the severity of illness, patients met the ir energy and protein intake goals through enteral or combined feeding with total parenteral nutrition. Serial weights (ie, obtained weekly) and serum albumin concentrations did not improve during hospitalizati on. Complications related to enteral feeding were minimal (<17% incide nce). Differences were noted between survivors and nonsurvivors: nonsu rvivors had lower serum albumin concentrations at the time of admissio n, had longer hospitalizations, and required total parenteral nutritio n for more days than the survivors. Nonetheless, even with extremely s ick patients, provision of enteral nutrition can be successful using t he administration techniques we describe. Enteral nutrition could best be provided by beginning at a slow rate (10 c3/hour), inserting the f eeding tube past the pylorus, and feeding according to sensible energy goals (25 kcal/kg of body weight), and using elemental then polymeric formulas.