It is frequently reported that critically-ill patients receive inadequate nutrition due to delays in initiating and interruptions to nutrition support, and enteral feeding protocols may minimize these(Reference Kreyman, Berger and Deutz1, Reference Heyland, Dhaliwal and Drover2). The current critical care protocol used advises that feeding should be considered within 24 h of admission and aims for a target rate of 80 ml/h, providing 8033 kJ/d. The aim was to establish when enteral nutrition is started, target rate achieved and to assess adequacy of energy provision. Data were collected over a 4-week period for adult patients admitted for level 3 critical care where enteral nutrition was started via a nasogastric (NG) tube and the patient anticipated to stay for more than 48 h. Data were collected from admission until the patient resumed oral intake, transferred to ward, died or at day 10.
Twenty patients met the inclusion criteria and 157 patient days were reviewed. There were twelve women and eight men, average age 53.2 (range 23–76) years. The average patient weight was 71 (range 45–110) kg and BMI 26.8 (range 15.6–47.6) kg/m2. Patients were fed for 144 d (92%). A total of 80% of patients started feeding within 24 h of admission, average 14.45 (range 1–52) h and 85% of patients subsequently achieved target rate within 48 h, average 21.7 (range 4–68) h. The average duration from admission to optimum rate was 36.7 (range 1–112) h. There were thirty-nine documented interruptions to NG feeding, average 1.95 (range 0–6) per patient. Reasons for interruptions were planned airway procedures (nineteen) and investigations (eight) and unplanned NG tube related (ten) and vomiting (two). Large gastric aspirates limited feeding for a further seven patient days and five patients received prokinetics.
Overall, an average of 65% target energy intake was achieved on days 1–3, increasing to 75% at day 4, 85% at day 5 and 80–82% between days 6–10. Patients fed at target protocol rate without interruption received an average 7682 kJ/d (95.6%) potential energy intake (range 7084–8167 kJ/d) or 108 (range 77.0–171) kJ/kg.
Despite small numbers, the present review suggests that enteral feeding via NG tube is well tolerated and can be commenced as soon as practically possible after admission to critical care. The average energy provision of 83.7 kJ/kg from day 3 is higher than reported in the literature and supports the use of a feeding protocol. Interruptions to feeding can be frequent and affect energy provision. Once target protocol rate has been achieved, feeding rates should be adjusted to compensate for planned and unplanned interruptions to feeding to ensure nutrition intake is not compromised.
