Skip to main content
SpringerLink
Log in

Risk Factors of Enternal Nutrition Intolerance in Septic Patients: A Case-control Study

  • Original Article
  • Published:
Current Medical Science Aims and scope Submit manuscript

Abstract

Objective

This study aimed to investigate the incidence of enteral nutrition intolerance (ENI) in patients with sepsis and explore potential risk factors.

Methods

A case-control study was conducted in patients with sepsis who were receiving enteral nutrition (EN) at a tertiary hospital in China. The included patients were divided into the ENI group and the non-ENI group. Univariate and multivariate analyses were performed to identify the risk factors for ENI.

Results

A total of 859 patients were included in the study. Among them, 288 (33.53%) patients experienced symptoms of ENI, including diarrhea, vomiting, bloating, and gastric retention. Logistic regression analysis revealed that the Acute Physiology and Chronic Health Evaluation H (APACHE H) score, thoracocentesis, and usage of cardiotonic drugs (namely, inotropes) were independent predictors of the ENI.

Conclusion

The incidence of ENI is relatively high in patients with sepsis, especially in those who have higher APACHE H scores, have undergone thoracocentesis, and have received inotropes.

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

Similar content being viewed by others

References

  1. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis 3). Jama, 2016,315(8):775–787

    Article  PubMed  PubMed Central  Google Scholar 

  2. Fleischmann-Struzek C, Mellhammar L, Rose N, et al. Incidence and mortality of hospital-and ICU-treated sepsis: results from an updated and expanded systematic. review and meta-analysis. Intensive Care Med, 2020,46(8):1552–1562

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. McClave SA, Lowen CC, Martindale RG. The 2016 ESPEN Arvid Wretlind lecture: The gut in stress. Clin Nutr, 2018,37(2):19–36

    Article  PubMed  Google Scholar 

  4. Rokyta R Jr, Matejovic M, Krouzecky A, et al. Postpyloric enteral nutrition in septic patients: Effects on hepato-splanchnic hemodynamics and energy status. Intensive Care Med, 2004,30(14):714–717

    Article  PubMed  Google Scholar 

  5. Gatt M, MacFie J, Anderson AD, et al. Changes in superior mesenteric artery bloodflow after oral, enteral, and parenteral feeding in humans. Crit Care Med, 2009,37(12):171–176

    Article  PubMed  Google Scholar 

  6. Evans L, Andrew R, Waleed A, et al. Executive summary: surviving sepsis campaign: international guidelines for the management of sepsis and septic shock 2021. Crit Care Med, 2021,49(11):1974–1982

    Article  PubMed  Google Scholar 

  7. Longhitano Y, Zanza C, Thangathurai D, et al. Gut alterations in septic patients: a biochemical literature reviews. Rev Recent Clin Trials, 2020,15(4):289–297

    Article  CAS  PubMed  Google Scholar 

  8. Blaser AR, Deane AM, Preiser JC, et al. Enteral feeding intolerance: updates in Definitions and Pathophysiology. Nutr Clin Pract, 2021,36(1):40–49

    Article  Google Scholar 

  9. Berk Takir H, Karakurt Z, Salturk C, et al. Does total parenteral nutrition increasethe mortality of patients with severe sepsis in the ICU? Turk Thorac J, 2015,16(2):53–58

    Article  Google Scholar 

  10. Lavrentieva A, Kontakiotis T, Bitzani M. Enteral nutrition intolerance in criticallyill septic burn patients. Burn Care Res, 2014,5(12):313–318

    Article  Google Scholar 

  11. Heyland DK, Ortiz A, Stoppe C, et al. Incidence, risk factors, and clinical consequence of enteral feeding intolerance in the mechanically ventilated critically ill: an analysis of a multicenter, multiyear database. Crit Care Med, 2021,49(1):49–59

    Article  PubMed  Google Scholar 

  12. Yu K, Guo N, Zhang D, et al. Prevalence and risk factors of enteral nutrition intolerance in intensive care unit patients: a retrospective study. Chin Med J (Engl), 2022,135(15):1814–1820

    Article  PubMed  Google Scholar 

  13. Paul S, Simon H, Marianne C, et al. Feeding the critically ill obese patient: a systematic review protocol. JBI Database Systematic Rev Implement Rep, 2015,13(10):95–109

    Article  Google Scholar 

  14. Jenkins B, Calder PC, Marino LV. A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults. Clin Nutr ESPEN, 2022,49:92–102

    Article  PubMed  Google Scholar 

  15. Xiao Y, Xu L. Prevalence and Risk Factors of Enteral Feeding Intolerance in Critically Ill Patients and the Effectiveness of Preventive Treatments: A Prospective Study. Saudi J Med Med Sci, 2023,11(2):135–142

    Article  PubMed  PubMed Central  Google Scholar 

  16. Chen T, Wang T, Li Q, et al. Current status and influencing factors of enteral. feeding intolerance in patients with severe acute pancreatitis. Chin J Nurs, 2017,52(6):716–720

    Google Scholar 

  17. Virani FR, Peery T, Rivas O. Incidence and Effects of Feeding Intolerance in Trauma Patients. JPEN J Parenter Enteral Nutr, 2019,43(6):742–749

    Article  CAS  PubMed  Google Scholar 

  18. Chen W, Wang H, Chen Y, et al. The independent risk factors of early diarrhea in enteral nutrition for ICU patients. J Int Med Res, 2019,47(10):4929–4939

    Article  PubMed  PubMed Central  Google Scholar 

  19. Haussner F, Chakraborty S, Halbgebauer R, et al. Challenge to the intestinal mucosa during sepsis. Front Immunol, 2019,10:891–907

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Bordejé ML, Montejo JC, Mateu ML, et al. Intra-Abdominal pressure as a marker of enteral nutrition intolerance in critically ill patients. the PIANE study. Nutrients, 2019,11(11):2616

    Article  PubMed  PubMed Central  Google Scholar 

  21. Zhao HB, Jia L, Yan QQ, et al. Effect of Clostridium butyricum and Butyrate on Intestinal Barrier Functions: Study of a Rat Model of Severe Acute Pancreatitis with Intra-Abdominal Hypertension. Front Physiol, 2020,11:561061

    Article  PubMed  PubMed Central  Google Scholar 

  22. Leng Y, Jiang C, Xing X, et al. Prevention of Severe Intestinal Barrier Dysfunction Through a Single-Species Probiotics is Associated with the Activation of Microbiome-Mediated Glutamate-Glutamine Biosynthesis. Shock, 2021,55(1):128–137

    Article  CAS  PubMed  Google Scholar 

  23. Regli A, Hockings LE, Musk GC, et al. Commonly applied positive end-expiratory pressures do not prevent functional residual capacity decline in the setting of intra-abdominal hypertension: a pig model. Crit Care, 2010,14(04):R128

    Article  PubMed  PubMed Central  Google Scholar 

  24. Regli A, Mahendran R, Fysh ET, et al. Matching positive end-expiratory pressure to intra-abdominal pressure improves oxygenation in a porcine sick lung model of intra-abdominal hypertension. Crit Care, 2012,16(05):R208

    Article  PubMed  PubMed Central  Google Scholar 

  25. Silva PL, Ball L, Rocco PRM, et al. Physiological and Pathophysiological. Consequences of Mechanical Ventilation. Semin Respir Crit Care Med, 2022,43(3):321–334

    Article  PubMed  Google Scholar 

  26. Santos CL, Moraes L, Santos RS, et al. Effects of different tidal volumes in pulmonary and extrapulmonary lung injury with or without intraabdominal hypertension. Intensive Care Med, 2012,38(03):499–508

    Article  PubMed  Google Scholar 

  27. Pelosi P, Luecke T, Rocco PR. Chest wall mechanics and abdominal pressure. during general anesthesia in normal and obese individuals and in acute lung injury. Curr Opin Crit Care, 2011,17(01):72–79

    Article  PubMed  Google Scholar 

  28. Gayen S. Malignant Pleural Effusion: Presentation, Diagnosis, and Management. Am J Med, 2022,135(10): 1188–1192

    Article  PubMed  Google Scholar 

  29. Cecconi M, Evans L, Levy M, et al. Sepsis and septic shock. Lancet, 2018,392(10141):75–87

    Article  PubMed  Google Scholar 

  30. Jacobi J. The pathophysiology of sepsis-2021 update: Part 2, organ dysfunction and assessment. Am J Health Syst Pharm, 2022,79(6):424–436

    Article  PubMed  Google Scholar 

  31. De Backer D, Arias Ortiz J, Levy B. The medical treatment of cardiogenic shock: cardiovascular drugs. Curr Opin Crit Care, 2021,27(4):426–432

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript and express our deep gratitude to Bin SHAO and Huang-kai SHOU for their valuable contributions to the data collection.

Author information

Authors and Affiliations

  1. Department of Nursing, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China

    Li-zhu Wang, Yan Xiang, Qian Li, Yi-rong Zhu, Jue Fang & Xiao-dan Lu

  2. Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China

    Zhao-cai Zhang

  3. Key Laboratory of the Diagnosis and Treatment for Severe Trauma and Burn of Zhejiang Province, Hangzhou, 310009, China

    Zhao-cai Zhang

  4. Zhejiang Province Clinical Research Center for Emergency and Critical Care Medicine, Hangzhou, 310009, China

    Zhao-cai Zhang

Authors
  1. Li-zhu Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yan Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Qian Li
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yi-rong Zhu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jue Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Xiao-dan Lu
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhao-cai Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhao-cai Zhang.

Ethics declarations

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Additional information

This work was supported by the National Key Research and Development Program of China (No. 2021YFC2501800), the National Natural Science Foundation of China (Nos. 82272182 and 82072202), the Zhejiang Provincial Natural Science Foundation of China (No. LHDMD22H02001) and the Zhejiang University Horizontal Program (No. K-Horizontal 20202295).

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Lz., Xiang, Y., Li, Q. et al. Risk Factors of Enternal Nutrition Intolerance in Septic Patients: A Case-control Study. CURR MED SCI 44, 328–332 (2024). https://doi.org/10.1007/s11596-024-2849-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11596-024-2849-3

Key words

Search

Navigation