Early enteral nutrition in the cardiothoracic intensive care unit.
OBJECTIVE
Early enteral nutrition (EN) improves intestinal integrity, motility and immunocompetence. However, technical problems such as diarrhoea and gastric residual volumes are said to be associated with the method and have prevented its implementation. We have prospectively assessed clinical problems connected to early EN.


METHODS
Seventy-three consecutive patients eligible for EN were assessed and observed until discharge from the intensive care unit (ICU) or until they resumed oral nutrition. They had surgery for coronary artery bypass grafting and/or valvular disease, thoracic or thoracoabdominal aortic aneurysms or other combined procedures. Two cardiac patients were not subjected to surgery.


RESULTS
In 59/73 patients, EN was started within 3 days. EN was discontinued in half of the patients when they were able to feed themselves. Twelve patients vomited, one of them severely. Dislocation of the nasogastric tube occurred in 28 patients. The 15 patients with diarrhoea were treated with 2-6 broad-spectrum antibiotics during their ICU-stay. Out of 73, 40 patients did not show any gastric residual volume (GRV). GRV decreased during EN in 50% of the patients with fairly large or large residual volumes. The incidence of aspiration pneumonia was 10%.


CONCLUSIONS
In the cardiothoracic ICU, individually adjusted early EN is feasible with few problems.
Department of Cardiothoracic Anesthesiology, Uppsala University Hospital, Uppsala, Sweden.
D R
DR
Kesek
L
L
Akerlind
T
T
Karlsson
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003967:Diarrhea / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D012115:Residual Volume; D012449:Safety; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology
D000900:Anti-Bacterial Agents