title: Enteral tube feeding in the intensive care unit: factors impeding adequate delivery.
abstract: OBJECTIVE
  To evaluate those factors that impact on the delivery of enteral tube feeding.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Medical intensive care units (ICU) and coronary care units at two university-based hospitals.
  
  
  METHODS
  Forty-four medical ICU/coronary care unit patients (mean age, 57.8 yrs; 70% male) who were to receive nothing by mouth and were placed on enteral tube feeding.
  
  
  METHODS
  Rate of enteral tube feeding ordered, actual volume delivered, patient position, residual volume, flush volume, presence of blue food coloring in oropharynx, and stool frequency were recorded every 4 hrs. Duration and reason for cessation of enteral tube feeding were documented.
  
  
  RESULTS
  Physicians ordered a daily mean volume of enteral tube feeding that was 65.6% of goal requirements, but an average of only 78.1% of the volume ordered was actually infused. Thus, patients received a mean volume of enteral tube feeding for all 339 days of infusion that was 51.6% of goal (range, 15.1% to 87.1%). Only 14% of patients reached > or = 90% of goal feeding (for a single day) within 72 hrs of the start of enteral tube feeding infusion. Of 24 patients weighed before and after, 54% were noted to lose weight on enteral tube feeding. Declining albumin levels through the enteral tube feeding period correlated significantly with decreasing percent of goal calories infused (p = .042; r2 = .13). Diarrhea occurred in 23 patients (52.3%) for a mean 38.2% of enteral tube feeding days. In >1490 bedside evaluations, patients were observed to be in the supine position only 0.45%, residual volume of >200 mL was found 2.8%, and blue food coloring was found in the oropharynx 5.1% of the time. Despite this, cessation of enteral tube feeding occurred in 83.7% of patients for a mean 19.6% of the potential infusion time. Sixty-six percent of the enteral tube feeding cessations was judged to be attributable to avoidable causes.
  
  
  CONCLUSIONS
  The current manner in which enteral tube feeding is delivered in the ICU results in grossly inadequate nutritional support. Barely one half of patient caloric requirements are met because of underordering by physicians and reduced delivery through frequent and often inappropriate cessation of feedings.
authors.affiliation: Department of Medicine, University of Louisville School of Medicine and Veterans' Affairs Medical Center, KY, USA.
authors.forename: S A
authors.initials: SA
authors.lastname: McClave
authors.forename: L K
authors.initials: LK
authors.lastname: Sexton
authors.forename: D A
authors.initials: DA
authors.lastname: Spain
authors.forename: J L
authors.initials: JL
authors.lastname: Adams
authors.forename: N A
authors.initials: NA
authors.lastname: Owens
authors.forename: M B
authors.initials: MB
authors.lastname: Sullins
authors.forename: B S
authors.initials: BS
authors.lastname: Blandford
authors.forename: H L
authors.initials: HL
authors.lastname: Snider
mesh_terms: D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies