Characterizing Gastrostomy Tube Feeding Intolerance in the Surgical Intensive Care Unit

Feeding intolerance (FI) after gastrostomy tube (GT) placement is understudied; however, it could have a significant impact on surgical intensive care unit (ICU) patients. The purpose of this study was to quantify the rate of FI after GT placement in patients who previously tolerated enteral nutrition (EN) and compare them to patients without FI after GT.

A single-center retrospective chart review from 2020 to 2023 analyzed surgical ICU patients who underwent GT placement. Intolerance was defined as cessation of EN due to nausea, vomiting, lack of gas or stool, abdominal distention, or high gastric residuals. Statistical analysis compared characteristics of patients with and without intolerance.

A total of 86 patients underwent GT placement, with 21 (24.4%) developing FI after placement. Patients tolerated feeds for a median of 1 d before requiring cessation, and feeds were restarted via GT after a median of 5 d. The most common reason for cessation was vomiting (42.9%). Among these patients, 52.3% required a change in the route of nutrition delivery, and of these, 23.8% required total parenteral nutrition. Compared to patients who tolerated EN, intolerant patients were younger (57 versus 35, P = 0.03).

FI after GT placement has not been characterized in the literature; however, it occurred in 24.4% of patients who had previously tolerated EN. Awareness of FI is critical to prevent malnutrition, as 52.3% required an alternate route for nutrition.