Enteral tube feeding in the intensive care unit: Factors impeding adequatedelivery

Objective: To evaluate those factors that impact on the delivery of enteral tube feeding. Design:Prospective study. Setting: Medical intensive care units (ICU) and coronary care units at two university-based hospitals. Patients: Forty-four medical ICU/coronary care unit patients (mean age, 57. 8 yrs; 70% male) who were to receive nothing by mouth and were placed on en teral tube feeding. Interventions: Rate of enteral tube feeding ordered, actual volume delivere d, patient position, residual volume, flush volume, presence of blue food c oloring in oropharynx, and stool frequency were recorded every 4 hrs. Durat ion and reason for cessation of enteral tube feeding were documented, Measurements and Main Results: Physicians ordered a daily mean Volume of en teral tube feeding that was 65.6% of goal requirements, but an average of o nly 78.1% of the volume ordered was actually infused. Thus, patients receiv ed a mean volume of enteral tube feeding for all 339 days of infusion that was 51.6% of goal (range, 15.1% to 87.1%), Only 14% of patients reached gre ater than or equal to 90% of goal feeding (for a single day) within 72 hrs of the start of enteral tube feeding infusion. Of 24 patients weighed befor e and after, 54% were noted to lose weight: on enteral tube feeding. Declin ing albumin levels through the enteral tube feeding period correlated signi ficantly with decreasing percent of goal calories infused (p = .042; r(2) = .13). Diarrhea occurred in 23 patients (52.3%) for a mean 38.2% of enteral tube feeding days, In >1490 bedside evaluations, patients were observed to be in the supine position only 0.45%, residual Volume of >200 mt was found 2.8%, and blue food coloring was found in the oropharynx 5.1% of the time. Despite this, cessation of enteral tube feeding occurred in 83.7% of patie nts for a mean 19.6% of the potential infusion time. Sixty-six percent of t he enteral tube feeding cessations was judged to be attributable to avoidab le causes, Conclusions:The current manner in which enteral tube feeding is delivered i n the ICU results in grossly inadequate nutritional support. Barely one hal f of patient caloric requirements are met because of underordering by physi cians and reduced delivery through frequent and often inappropriate cessati on of feedings.