Summary of the Best Evidence for Tube Feeding Intolerance in Critically Ill Children

Objective:To summarize the evidence of tube feeding intolerance in critically ill children,aiming to provide evidence-based information for clinical nursing staff.Methods:Evidence search was done in Chinese and English databases to guide network and professional associations at home and abroad.The search time limit was from January 2014 to January 2024,nearly 10 years of relevant literature,mainly including guidelines,consensus,expert advice,best practice,evidence summary,system evaluation,and meta-analysis.Literature quality evaluation and evidence extraction were independently performed by two researchers.Results:This paper included 13 articles,including three guidelines,three systematic evaluations,three expert opinions,and four expert consensus.Twenty-six pieces of evidence were summarized from 10 aspects of feeding intolerance definition,team building,nutritional assessment,nutritional preparation,feeding protocol,feeding route,feeding management,pipeline management,gastric residual volume,and drug application.Conclusion:This paper summarized the evidence of tube feeding intolerance in critically ill children,which can provide evidence-based information for clinical practice.The abdominal signs should be closely observed when evaluating feeding intolerance,focusing on the prevention and reduction of feeding interruption.

Early warning systems for enteral feeding intolerance in patients with stroke

Objective:The objective of this study was to construct an early warning system(EWS)to facilitate risk assessment,early identification,and appropriate treatment of enteral nutrition feeding intolerance(FI)in patients with stroke,so as to provide a reference for risk classification standards and interventions toward a complete EWSs for nursing care of stroke.Materials and Methods:Based on evidence and clinical nursing practice,a structured expert consultation method was adopted on nine experts over two rounds of consultation.Statistical analysis was used to determine the early warning index for FI in patients with stroke.Results:The expert authority coefficient was 0.89;the coefficients of variation for the two rounds of consultation were 0.088-0.312 and 0.096-0.214,respectively.There were significant differences in the Kendall’s concordance coefficient(P<0.05).Finally,22 items in five dimensions of patient age,disease,treatment,biochemical,and enteral nutrition-related factors were identified.Conclusion:The early warning index for FI in patients with a history of stroke is valid and practical.It provides a reference for the early clinical identification of FI risk.

Development of a prediction model for enteral feeding intolerance in intensive care unit patients:A prospective cohort study

BACKGROUND Enteral nutrition(EN)is essential for critically ill patients.However,some patients will have enteral feeding intolerance(EFI)in the process of EN.AIM To develop a clinical prediction model to predict the risk of EFI in patients receiving EN in the intensive care unit.METHODS A prospective cohort study was performed.The enrolled patients’basic information,medical status,nutritional support,and gastrointestinal(GI)symptoms were recorded.The baseline data and influencing factors were compared.Logistic regression analysis was used to establish the model,and the bootstrap resampling method was used to conduct internal validation.RESULTS The sample cohort included 203 patients,and 37.93%of the patients were diagnosed with EFI.After the final regression analysis,age,GI disease,early feeding,mechanical ventilation before EN started,and abnormal serum sodium were identified.In the internal validation,500 bootstrap resample samples were performed,and the area under the curve was 0.70(95%CI:0.63-0.77).CONCLUSION This clinical prediction model can be applied to predict the risk of EFI.

Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study

Background: Feeding intolerance (FI) among intensive care unit (ICU) patients undergoing early continuous enteral nutrition (EN) is related to poor outcomes. This study aimed to explore the prevalence and risk factors of FI in ICU patients.Methods: We retrospectively enrolled 1057 patients who received early continuous EN via a nasogastric tube between January 2014 and August 2019. The prevalence of FI during the first 7 days of ICU stay was calculated, and the risk factors were investigated using multivariate logistic regression analysis.Results: The prevalence of FI during the first 7 days of ICU stay was 10.95%. FI occurred in 159 of 1057 (15.04%) patients on ICU day 2, 114 of 977 (11.67%) patients on ICU day 3, and 86 of 715 (12.03%) patients on ICU day 7. Mechanical ventilation (MV) (odds ratio [OR]: 1.928, 95% confidence interval [CI]: 1.064–3.493,P = 0.03) was an independent risk factor for FI defined by a gastric residual volume (GRV) of 200 mL and/or vomiting, and acute renal failure (OR: 3.445, 95% CI: 1.115–10.707,P = 0.032) was an independent risk factor of FI defined by a GRV of 500 mL and/or vomiting. Continuous renal replacement therapy (CRRT) was an independent predictor regardless of the FI defined by a GRV of 200 mL (OR: 2.064, 95% CI: 1.233–3.456,P = 0.006) or 500 mL (OR: 6.199, 95% CI: 2.108–18.228,P = 0.001) in the ICU patients.Conclusions: FI occurs frequently in early ICU days, especially in patients receiving MV and CRRT. However, further investigation of a consensus definition of FI and risk factors is still warranted in future studies.

Comparison of sequential feeding and continuous feeding on the blood glucose of critically ill patients:a non-inferiority randomized controlled trial

Background:Glucose control is an important aspect in managing critically ill patients.The goal of this study was to compare the effects of sequential feeding(SF)and continuous feeding(CF)on the blood glucose of critically ill patients.Methods:A non-inferiority randomized controlled trial was adopted in this study.A total of 62 patients who were fed enteral nutritional suspension through gastric tubes were enrolled.After achieving 80%of the nutrition target calories(25 kcal·kg^(-1)·day^(-1))through CF,the patients were then randomly assigned into SF and CF groups.In the SF group,the feeding/fasting time was reasonably determined according to the circadian rhythm of the human body as laid out in traditional Chinese medicine theory.The total daily dosage of the enteral nutritional suspension was equally distributed among three time periods of 7 to 9 o’clock,11 to 13 o’clock,and 17 to 19 o’clock.The enteral nutritional suspension in each time period was pumped at a uniform rate within 2 h by an enteral feeding pump.In the CF group,patients received CF at a constant velocity by an enteral feeding pump throughout the study.Blood glucose values at five points(6:00/11:00/15:00/21:00/1:00)were monitored and recorded for seven consecutive days after randomization.Enteral feeding intolerance was also recorded.Non-inferiority testing was adopted in this study,the chi-square test or Fisher test was used for qualitative data,and the Mann-Whitney U test was used for quantitative data to determine differences between groups.In particular,a repeated measure one-way analysis of variance was used to identify whether changes in glucose value variables across the time points were different between the two groups.Results:There were no significant demographic or physiological differences between the SF and CF groups(P>0.050).The average glucose level in SF was not higher than that in CF(8.8[7.3–10.3]vs.10.7[9.1–12.1]mmol/L,Z=-2.079,P for non-inferiority=0.019).Hyperglycemia incidence of each patient was more common in the CF group than that in the SF group(38.4[19.1–63.7]%vs.11.8[3.0–36.7]%,Z=-2.213,P=0.027).Hypoglycemia was not found in either group.Moreover,there was no significant difference during the 7 days in the incidence of feeding intolerance(P>0.050).Conclusions:In this non-inferiority study,the average blood glucose in SF was not inferior to that in CF.The feeding intolerance in SF was similar to that in CF.SF may be as safe as CF for critically ill patients.