Compensatory increased enteral feeding goal rates: a way to achieve optimal nutrition

Traditionally, enteral nutrition (EN) goal rates have been calculated based on an intended continuous 24-hour infusion rate. Many factors in the care of critically ill patients result in interruption of EN infusions, often for several hours daily, which may lead to significant underfeeding. The objective of this study was to evaluate the difference of daily EN volume deficits between a traditionally calculated infusion rate and a compensatory, higher calculated infusion rate in which the 24-hour volume was delivered over a 20-hour infusion period.

Data collection consisted of daily EN volume deficit (intended volume - actual volume infused), based on intensive care unit nursing flow sheets. The primary outcome was daily EN volume deficit from a standard 24-hour calculated goal rate, compared with volume deficit from delivery of the same volume over 20 hours. For the 20-hour group, the calculated daily requirement of EN was divided by 20 rather than 24 for the higher hourly rate but still delivered for 24 hours.

One hundred ten baseline (24-hour) EN days were evaluated with a mean infusion volume deficit of (±)247 mL/d. This compared with 158 patients in the 20-hour infusion group, in which the mean volume deficit was (±)45 mL/d (P < .001). Enteral nutrition was most often held for extubation or procedures. A higher level of overfeeding was noted in the 20-hour infusion group.

Calculating and prescribing higher EN infusion rates, assuming 20 hours of actual infusion daily, promoted delivery of optimal nutrient provisions and avoidance of unintended malnutrition by significantly reducing caloric deficit from frequent EN holding.