title: Formula delivery in patients receiving enteral tube feeding on general hospital wards: the impact of nasogastric extubation and diarrhea.
abstract: OBJECTIVE
  In contrast to the intensive care unit, little is known of the percentage of formula delivered to patients receiving enteral tube feeding (ETF) on general wards or of the complications that affect its delivery. This study prospectively investigated the incidence of nasogastric extubation and diarrhea in patients starting ETF on general wards and examined their effect on formula delivery.
  
  
  METHODS
  In a prospective observational study, the volume of formula delivered to patients receiving ETF on general wards was compared with the volume prescribed. The incidence of nasogastric extubation and diarrhea was measured and its effect on formula delivery calculated.
  
  
  RESULTS
  Twenty-eight patients were monitored for a total of 319 patient days. The mean +/- SD volume of formula prescribed was 1460 +/- 213 mL/d, whereas the mean volume delivered was only 1280 +/- 418 mL/d (P < 0.001), representing a mean percentage delivery of 88 +/- 25% of prescribed formula. Nasogastric extubation occurred in 17 of 28 patients (60%), affecting 53 of the 319 patient days (17%). The percentage of formula delivered on days when the nasogastric tube remained in situ was 96 +/- 12% and on days when nasogastric extubation occurred it was only 45 +/- 31% (P < 0.001). Diarrhea affected 39 of 319 patient days (12%) but there was no difference in formula delivery on days when diarrhea did or did not occur (78% versus 89%, P = 0.295). There was a significant, albeit small, negative correlation between the daily stool score and formula delivery (correlation coefficient -0.216, P < 0.001).
  
  
  CONCLUSIONS
  Formula delivery is marginally suboptimal in patients receiving ETF on general wards. Nasogastric extubation is common and results in an inherent cessation of ETF until the nasogastric tube is replaced and is therefore a major factor impeding formula delivery. Diarrhea is also common but does not result in significant reductions in formula delivery.
authors.affiliation: Nutritional Sciences Research Division, King's College London, London, UK. kevin.whelan@kcl.ac.uk
authors.forename: Kevin
authors.initials: K
authors.lastname: Whelan
authors.forename: Lydia
authors.initials: L
authors.lastname: Hill
authors.forename: Victor R
authors.initials: VR
authors.lastname: Preedy
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Judd
authors.forename: Moira A
authors.initials: MA
authors.lastname: Taylor
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000209:etiology; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005526:Food, Formulated / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007441:Intubation, Gastrointestinal / Q000009:adverse effects*; D008297:Male; D009751:Nutritional Requirements; D010043:Outcome and Process Assessment, Health Care; D011446:Prospective Studies