Open versus closed enteral nutrition systems for critically ill adults: is there a difference?

To compare the volume, total calories, and protein received by critically ill patients between open and closed enteral nutrition (EN) systems and identify the main reasons for EN discontinuation.

A cohort study in which adult patients admitted to the intensive care unit (ICU) were followed-up in two periods: throughout November 2009 with all patients (n = 85) receiving EN using the open system (OS group); and from October 2010 to April 2011 with patients (n = 170) receiving EN using the closed system (CS group). Parametric and nonparametric tests were used to compare the variables, taking into account their distribution.

Demographic and clinical characteristics were similar in both groups. There were minor differences with no statistical significance between groups: more calories/kg were prescribed to the OS group (p < 0.001), and a higher volume (mL/kg, p = 0.002) and protein (g/kg, p = 0.001) were prescribed to the CS group. Fasting, enteral feeding or gastrointestinal problems, and performance of procedures and ICU routines in different frequencies between groups (p = 0.001) led to the discontinuation of EN.

There was no clinically relevant difference between the volume, energy, and protein intake of EN prescribed and administered in OS and CS groups. Clinical instability, procedures, and ICU routines led to EN discontinuation in both groups.