Skip to main content
SpringerLink
Log in

Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients

  • Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Objective

To compare the initial (D7) calorie intake and tolerability of two early enteral nutrition protocols in which the optimal flow rate was introduced either immediately or gradually.

Design

Open, prospective, randomized study.

Setting

Two medical-surgical intensive care units.

Patients

One hundred consecutive intubated and mechanically ventilated patients.

Interventions

Early enteral nutrition was started within 24 h following intubation, and the optimal flow rate (25 Kcal/kg day−1) was either introduced immediately or reached in increments. Flow rate of the nutritional solution was adapted to the residual gastric volume, measured every 8 h, and the use of prokinetic agents was encouraged. Vomiting, regurgitation, colectasia, and suspected aspiration were defined as serious adverse events requiring withdrawal of enteral nutrition.

Measurements and results

When introduced immediately at optimal flow rate, early enteral nutrition led to a significant improvement in actual calorie supply (p < 0.0001). Although high residual gastric volume (> 300 ml) was more frequent when optimal flow rate was introduced immediately ( p = 0.04), frequency of serious adverse events necessitating withdrawal of enteral nutrition was similar in the two groups (p = 0.64).

Conclusions

When residual gastric volume is measured regularly and prokinetic agents are used, enteral nutrition can be started early and be introduced at optimal dose regimen, thereby providing better calorie intake. Serious adverse events required early enteral nutrition withdrawal in only 15 patients, with no difference in frequency between the groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dobek P, The Canadian Critical Care Clinical Practice Guidelines Committee (2003) Canadian clinical practice guidelines committee for nutrition support in mechanically ventilated critically ill adult patients. JPEN 27:355–373

    Google Scholar 

  2. Jolliet P, Pichard C, Biolo G, Chioléro R, Grimble G, Leverve X, Nitenberg G, Novak I, Planas M, Preiser JC, Roth E, Schols AM, Wernerman J (1998) Enteral nutrition in intensive care patients: a practical approach. Intensive Care Med 24:848–859

    Article  PubMed  CAS  Google Scholar 

  3. Marik PE, Zaloga GP (2001) Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med 29:2264–2270

    Article  PubMed  CAS  Google Scholar 

  4. De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, Outin H (2001) A prospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered? Crit Care Med 29:8–12

    Article  PubMed  Google Scholar 

  5. Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G (2001) Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 29:1955–1961

    Article  PubMed  CAS  Google Scholar 

  6. Ibrahim EH, Mehringer L, Prentice D, Sherman G, Schaiff R, Fraser V, Kollef MH (2002) Early versus late enteeral feeding of mechanically ventilated patients: results of a clinical trial. JPEN 26:174–181

    Google Scholar 

  7. Pinilla JC, Samphire J, Arnold C, Liu L, Thiessen B (2001) Comparaison of gastrointestinal tolerance to two enteral feeding protocols in critically ill patients: a prospective, randomized controlled trial. JPEN 25:81–86

    CAS  Google Scholar 

  8. Heyland D, Cook DJ, Winder B, Brylowski L, Van demark H, Guyatt G (1995) Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med 23:1055–1060

    Article  PubMed  CAS  Google Scholar 

  9. McClave SA, Sexton LK, Spain DA, Adams JL, Owens NA, Sullins MB, Blandford BS, Snider HL (1999) Enteral tube feeding in the intensive care unit: factors impending adequate delivery. Crit Care Med 27:1252–1256

    Article  PubMed  CAS  Google Scholar 

  10. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score (SAPS II) based on an European north American multicenter study. J Am Med Assoc 270:2957–2963

    Article  Google Scholar 

  11. Reignier J, Bensaid S, Perrin-Gachdoat D, Burdin M, Boiteau R, Tenaillon A (2002) Erythromycin and early enteral nutrition in mechanically ventilated patients. Crit Care Med 30:1237–1241

    Article  PubMed  CAS  Google Scholar 

  12. Adam S, Batson S (1997) A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med 23:261–266

    Article  PubMed  CAS  Google Scholar 

  13. McClave SA, Lukan LK, Stefater JA, Lowen CC, Looney SW, Matheson PJ, Gleeson K, Spain DA (2005) Poor validity of residual volumes as a marker for risk of aspiration in critically ill patients. Crit Care Med 33:324–330

    Article  PubMed  Google Scholar 

  14. Van Der Spoel JI, Schultz MJ, Van Der Voort PHJ, De Jonghe E (2006) Influence of severity of illness, medication and selective decontamination on defecation. Intensive Care Med 32:875–880

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

In addition to the co-authors of this article, the following investigators participated in the study: O. Baudin; S. Calvat (Angoulême); and P. Vignon (Limoges).

Author information

Authors and Affiliations

  1. Service de Réanimation Polyvalente, Centre Hospitalier d’Angoulême, 16470, Saint Michel, France

    Arnaud Desachy, Albert Vuagnat & Valérie Gissot

  2. Medical-Surgical Intensive Care unit, Hôpital Universitaire Dupuytren, Limoges, France

    Marc Clavel, Sandrine Normand & Bruno François

  3. Clinical Research Center, Hôpital Universitaire Dupuytren, Limoges, France

    Marc Clavel & Bruno François

Authors
  1. Arnaud Desachy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Marc Clavel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Albert Vuagnat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandrine Normand
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valérie Gissot
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Bruno François
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Arnaud Desachy.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Desachy, A., Clavel, M., Vuagnat, A. et al. Initial efficacy and tolerability of early enteral nutrition with immediate or gradual introduction in intubated patients . Intensive Care Med 34, 1054–1059 (2008). https://doi.org/10.1007/s00134-007-0983-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-007-0983-6

Keywords

Search

Navigation