Comparison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: A prospective, randomized controlled trial

Background: The purpose of this study was to compare gastrointestinal toler ance to two enteral feeding protocols in critically ill patients. Methods: A prospective, randomized controlled trial, that involved 96 consecutive pa tients expected to stay in the intensive care unit for greater than or equa l to3 days and who had no contraindications to enteral feeding. The patient s were randomized to either the current protocol (group I; gastric residual volume threshold, 150 mL, optional prokinetic) or proposed feeding protoco l (group IT; gastric residual volume threshold 250 mL, mandatory prokinetic ). Gastrointestinal intolerance was recorded as episodes of high gastric re sidual volume, emesis, or diarrhea. The time to reach the goal rate of feed ing and the percentage of nutritional requirements received during the stud y period were also recorded: Results: Nineteen of 36 patients (19/36 = 0.53 ) in group I had one or more episodes of high gastric residual volume, comp ared with 10 of 44 patients (10/44 = 0.23) in group II (p<.005). There was no statistical difference between the two protocols with regards to emesis, diarrhea, or the total episodes of intolerance. The patients in group II r eached their goal rates on average in 15 hours and received 76% of their nu tritional requirements, compared with 22 hours and 70% in group I; however, these differences were not statistically significant. Conclusions: The inc idence of enteral feeding intolerance was reduced by using a gastric residu al volume of 250 mt along with the mandatory use of prokinetics. The study showed a trend of improved enteral nutrition provision and reduced the time to reach the goal rate in group II. These improvements support the adoptio n of the proposed feeding protocol for critically ill patients.