Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study

Hyunjung Kim

doi:10.7475/KJAN.2013.25.4.444

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Kim: Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study

Original Research

Korean J Adult Nurs 2013;25(4):444-453.

Published online: 18 August 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.4.444

Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study

Hyunjung Kim

Division of Nursing ‧ Research Institute of Nursing Science, Hallym University, Chuncheon, Korea

Corresponding author: Kim, Hyunjung Division of Nursing, Hallym University, 1 Hallymdaehak-gil, Chuncheon, 200-702, Korea. Tel: +82-33-248-2712, Fax: +82-33-248-2734, E-mail: hjkim97@hallym.ac.kr

Received 6 March 201325 July 2013 Accepted 13 August 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to describe the differences between early and delayed enteral nutrition on nutritional intake.

Methods

A pilot cohort study was conducted with 45 critically ill adult patients who had a primary medical diagnosis. Energy prescribed and received were collected during the four days after initiation of enteral nutrition. Adequate feeding was defined as the energy intake more than 90% of required energy.

Results

A total of 23 patients (52%) were received early enteral nutrition (within 48 hours of admission). Energy intake of early enteral nutrition was less than intake of delayed enteral nutrition during the four days of the study. Although the difference on day one was significantly greater than the differences on day two, the differences on day two were not different from days three or four. No statistical differences in the adequacy of nutritional intake were found between patients in the early and the delayed group.

Conclusion

In critically ill patients receiving early enteral nutrition, more aggressive administration from the beginning will improve the nutritional intake. Additional studies including a large multi-centre, randomized clinical trial are recommended.

Keywords: Early enteral nutrition, Intensive care units, Nutritional intake

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Figure 1.

Trend in daily energy intake of early and delayed enteral nutrition

Table 1.

Characteristics of Participants (N=45)

Characteristics	Categories	Early nutrition (n=23)	Delayed nutrition (n=22)	x² or t	p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	p
Age(year)		71.7±13.8	66.1±15.0	1.29	.203
	≤54	2 (8.7)	5 (22.7)	2.74	.601
	55~64	4 (17.4)	3 (13.6)
	65~74	5 (21.7)	6 (27.3)
	75~84	9 (39.1)	7 (31.8)
	≥85	3 (13.1)	1 (4.6)
Gender	Male	9 (39.1)	13 (59.1)	-0.20	.189
Gender	Female	14 (60.9)	9 (40.9)	-0.20	.189
Diagnosis	Gastrointestinal	0 (0.0)	2 (9.1)	-0.21	.158
	Neurological	13 (56.5)	9 (40.9)
	Sepsis	1 (4.3)	2 (9.1)
	Renal	3 (13.1)	3 (13.6)
	Respiratory	6 (26.1)	6 (27.3)
APACHE II score		11.2±5.6	15.6±6.0	-2.50	.016
Serum albumin (mg)		3.4±0.8	3.2±0.6	-0.16	.875
Serum CRP (mg)		3.7±5.0	7.1±7.2	-1.78	.082
BMI	Underweight (＜18.5)	2 (8.7)	2 (9.1)	-0.04	.804
	Healthy weight (18.5~22.9)	8 (34.8)	8 (36.4)
	Over weight (23~24.9)	8 (34.8)	6 (27.3)
	Mild obese (25~25.9)	5 (21.7)	6 (27.3)
Feeding tube location	Nasogastric tube	23 (100.0)	22 (100.0)	-	-
Feeding tube size	16 Fr	12 (52.2)	12 (54.5)	-0.02	.877
Feeding tube size	18 Fr	11 (47.8)	10 (45.5)	-0.02	.877
Feeding formula	Isocaloric	20 (87.0)	15 (68.2)	2.29	.130
Feeding formula	Calorically dense	3 (13.0)	7 (31.8)	2.29	.130
Prokinetics	No	20 (87.0)	17 (77.3)	0.55	.458
Prokinetics	Yes	3 (13.0)	5 (22.7)	0.55	.458
Gastric residual	Low(＜50)	17 (73.9)	14 (63.6)	0.75	.477
Gastric residual	High(≥50ml)	6 (26.1)	8 (36.4)	0.75	.477
Diarrhea	No	18 (78.2)	12 (54.5)	3.52	.061
Diarrhea	Yes	5 (21.8)	10 (45.5)	3.52	.061
Vomiting	No	22 (95.6)	20 (90.9)	1.89	.169
Vomiting	Yes	1 (4.4)	2 (9.1)	1.89	.169

APACHE II=acute physiology chronic health evaluation II; CRP=C-reactive protein; BMI=body mass index.

Table 2.

Interaction between Energy received in the Early and Delayed Nutrition Group and Time (N=45)

Variables	Categories	Early nutrition (n=23)	Delayed nutrition (n=22)	Between group	Within group
		Early nutrition (n=23)	Delayed nutrition (n=22)	Group	Time	Time×Group
		M±SD (kcal)	M±SD (kcal)	F (p)^†	F (p)^†	F (p)^†
Energy received (total)	Day1	714±236	1,203±422	13.89 (.001)	0.90 (.455)	5.59 (.004)
	Day2	921±282	1,122±402
	Day3	1,132±189	1,136±243
	Day4	1,075±263	1,160±242
	Mean	958±161	1,165±189
Energy received (enteral)	Day1	548±124	893±201	4.54 (.041)	1.71 (.187)	2.60 (.057)
	Day2	854±234	1,003±259
	Day3	1,103±177	1,071±236
	Day4	1,075±263	1,116±237
	Mean	892±160	1,012±178
Energy required		1,228±230	1,377±317

^† Controlling for APACHE II scores.

Table 3.

Comparison of Under- and Adequate Feeding in the Early and Delayed Enteral Nutrition Group (N=45)

Variables	Early nutrition (n=23)	Delayed nutrition (n=22)	x²†	p
Variables	n (%)	n (%)	x²†	p
Underfeeding	17 (73.9)	11 (50.0)	2.76	.089
Adequate feeding	6 (26.1)	11 (50.0)

^† Controlling for APACHE II scores.

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