Enteral nutrition-related gastrointestinal complications in critically ill patients

Objective To evaluate the frequency of gastrointestinal complications (GICs) in a prospective cohort of critically ill patients receiving enteral nutrition and to assess its effect on nutrient administration and its relationship to the patient's outcome. Design Multicenter, prospective cohort study. Setting Thirty-seven multidisciplinary intensive care units (ICUs) in Spain. Patients Prospective cohort of 400 consecutive patients admitted to the ICU and receiving enteral nutrition. Interventions Noninterventional, follow-up study. Measurements and Main Results Enteral nutrition-related GICs and their management were defined by consensus before data collection. A set of variables related to enteral nutrition administration and the presence of GICs was recorded. During the 1-month study period, 400 patients were enrolled, and a total of 3,778 enteral feeding days were analyzed. The mean time of enteral nutrition was 9.6 +/- 0.4 days. Mean elapsed time from ICU admission to the start of enteral feeding was 3.1 +/- 0.2 days. A total of 265 patients (66.2%) received a standard polymeric formula, and 132 (33.8%) received a disease-specific one. Enteral feeds were administered mainly through a nasogastric tube (91%). One or more GICs were presented by 251 patients (62.8%) during the feeding course. The frequency of each particular GIC was as follows: high gastric residuals, 39%; constipation, 15.7%; diarrhea, 14.7%; abdominal distention, 13.2%; vomiting, 12.2%; and regurgitation, 5.5%. Enteral nutrition withdrawal as a consequence of noncontrollable GICs occurred in 15.2% of patients. The volume ratio (expressed as the ratio between administered and prescribed volumes) was calculated daily and was used as an index of diet administration efficacy. Patients with GICs had a lower volume ratio than did patients without GICs (63.1 +/- 1.2% vs. 93.3 +/- 0.3%) (p < .001), a longer length of stay (20.6 +/- 1.2 vs. 15.2 +/- 1.3 days) (p < .01), and higher mortality (31% vs. 16.1%) (p < .001). Conclusions The frequency of enteral nutrition-related GICs in critically ill patients is high. High gastric residuals is the most frequent GIC. These complications decreased nutrient intake and, if persistent, could expose the patients to undernutrition. Enteral feeding gastrointestinal intolerance seems to have an evolutive effect in prolonging the ICU stay and increasing patient mortality. (Crit Care Med 1999; 27:1447-1453)