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Early enteral nutrition in the cardiothoracic intensive care unit
D R Kesek1, L Akerlind, T Karlsson
1Department of Cardiothoracic Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
Insights
Early enteral nutrition (EN) is feasible in cardiothoracic intensive care units (ICUs) with few complications. This study assessed clinical issues associated with early EN, finding it manageable for most patients.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Surgical Nutrition
Background:
- Early enteral nutrition (EN) supports intestinal integrity, motility, and immunocompetence.
- Technical issues like diarrhea and high gastric residual volumes (GRV) can hinder early EN implementation.
- Assessing clinical problems associated with early EN is crucial for its effective use.
Purpose of the Study:
- To prospectively evaluate the clinical problems encountered with early enteral nutrition in cardiothoracic intensive care unit (ICU) patients.
- To determine the feasibility and safety of initiating EN within three days of admission.
Main Methods:
- Prospective observational study of 73 consecutive patients eligible for EN in a cardiothoracic ICU.
- Patients were monitored until discharge or resumption of oral nutrition.
- Data collected included EN initiation, discontinuation, tube dislocations, vomiting, diarrhea, GRV, and aspiration pneumonia incidence.
Main Results:
- EN was initiated within 3 days for 59/73 patients.
- Nasogastric tube dislocation occurred in 28 patients; 12 patients vomited.
- Diarrhea affected 15 patients, and aspiration pneumonia occurred in 10% of patients.
Conclusions:
- Individually adjusted early enteral nutrition is feasible in the cardiothoracic ICU setting.
- Despite some technical challenges, early EN can be managed effectively with careful monitoring.
- The benefits of early EN in improving patient outcomes warrant its continued use with appropriate adjustments.
Background And Aims:
Early enteral nutrition (EN) improves intestinal integrity, motility and immunocompetence. However, technical problems such as diarrhoea and gastric residual volumes are said to be associated with the method and have prevented its implementation. We have prospectively assessed clinical problems connected to early EN.
Patients And Methods:
Seventy-three consecutive patients eligible for EN were assessed and observed until discharge from the intensive care unit (ICU) or until they resumed oral nutrition. They had surgery for coronary artery bypass grafting and/or valvular disease, thoracic or thoracoabdominal aortic aneurysms or other combined procedures. Two cardiac patients were not subjected to surgery.
Results:
In 59/73 patients, EN was started within 3 days. EN was discontinued in half of the patients when they were able to feed themselves. Twelve patients vomited, one of them severely. Dislocation of the nasogastric tube occurred in 28 patients. The 15 patients with diarrhoea were treated with 2-6 broad-spectrum antibiotics during their ICU-stay. Out of 73, 40 patients did not show any gastric residual volume (GRV). GRV decreased during EN in 50% of the patients with fairly large or large residual volumes. The incidence of aspiration pneumonia was 10%.
Conclusion:
In the cardiothoracic ICU, individually adjusted early EN is feasible with few problems.