title: Tube feeding in mechanically ventilated critically ill patients: a prospective clinical audit.
abstract: BACKGROUND
  When and whether early enteral nutrition (EN) benefits critically ill patients is debatable. This prospective clinical audit aimed to evaluate the feasibility of an early EN protocol and to identify factors that may hinder EN delivery in critically ill patients.
  
  
  METHODS
  Thirty-six medical patients with severe respiratory failure under invasive ventilation and scheduled to receive early EN, with a length of ICU stay >72 hours, were included. As asserted by the Society of Critical Care Medicine, 8% of patients were priority 1, 72% priority 2, and 20% priority 3 for intensive therapeutic and vital support interventions.
  
  
  RESULTS
  Overall, because of gastrointestinal complications, only 39% of the prescribed EN was administered; only 8 (22%) patients did tolerate EN within the first 48 hours after admission and did achieve their minimum nutritional requirements. The most frequent complication (78%) was high volume of gastric residuals followed by abdominal distention (61%), both associated with hemodynamic instability (HI). Gastrointestinal dysfunction was associated with high Acute Physiologic and Chronic Health Evaluation II score (p = .01), total calorie intake (p = .02), total carbohydrate intake (p = .02), HI (p = .03), malnutrition (p = .04), volume of IV saline (p = .04), and concurrent vasoactive drug administration (p = .05).
  
  
  CONCLUSIONS
  This audit in extremely severe intensive care patients identified several factors that impair gastrointestinal function and preclude EN at any stage, namely early EN. Nutrition management must take into account concurrent therapies, given their potential interference with nutrition and organ function.
authors.affiliation: Center of Nutrition and Metabolism, Institute of Molecular Medicine, Faculty of Medicine of the University of Lisbon, Portugal. p.ravasco@fm.ul.pt
authors.forename: Paula
authors.initials: P
authors.lastname: Ravasco
authors.forename: Maria Ermelinda
authors.initials: ME
authors.lastname: Camilo