title: Evaluation of delivery of enteral nutrition in critically ill patients receiving mechanical ventilation.
abstract: BACKGROUND
  Published reports consistently describe incomplete delivery of prescribed enteral nutrition. Which specific step in the process delays or interferes with the administration of a full dose of nutrients is unclear.
  
  
  OBJECTIVE
  To assess factors associated with interruptions in enteral nutrition in critically ill patients receiving mechanical ventilation.
  
  
  METHODS
  An observational prospective study of 59 consecutive patients who required mechanical ventilation and were receiving enteral nutrition was done in an 18-bed medical intensive care unit of an academic center. Data were collected prospectively on standardized forms. Steps involved in the feeding process from admission to discharge were recorded, each step was timed, and delivery of nutrition was quantified.
  
  
  RESULTS
  Patients received approximately 50% (mean, 1106.3; SD, 885.9 Cal) of the prescribed caloric needs. Enteral nutrition was interrupted 27.3% of the available time. A mean of 1.13 interruptions occurred per patient per day; enteral nutrition was interrupted a mean of 6 (SD, 0.9) hours per patient each day. Prolonged interruptions were mainly associated with problems related to small-bore feeding tubes (25.5%), increased residual volumes (13.3%), weaning (11.7%), and other reasons (22.8%). Placement and confirmation of placement of the small-bore feeding tube were significant causes of incomplete delivery of nutrients on the day of admission.
  
  
  CONCLUSIONS
  Delivery of enteral nutrition in critically ill patients receiving mechanical ventilation is interrupted by practices embedded in the care of these patients. Evaluation of the process reveals areas to improve the delivery of enteral nutrition.
authors.affiliation: Department of Nursing, Cleveland Clinic, Cleveland, Ohio 44195, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: O'Meara
authors.forename: Eduardo
authors.initials: E
authors.lastname: Mireles-Cabodevila
authors.forename: Fran
authors.initials: F
authors.lastname: Frame
authors.forename: A Christine
authors.initials: AC
authors.lastname: Hummell
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hammel
authors.forename: Raed A
authors.initials: RA
authors.lastname: Dweik
authors.forename: Alejandro C
authors.initials: AC
authors.lastname: Arroliga
mesh_terms: D000006:Abdomen, Acute / Q000453:epidemiology; D001494:Baths / Q000706:statistics & numerical data; D003422:Critical Care; D016638:Critical Illness; D004750:Enteral Nutrition; D004868:Equipment Failure; D005260:Female; D005766:Gastrointestinal Contents; D006471:Gastrointestinal Hemorrhage / Q000453:epidemiology; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D009820:Ohio / Q000453:epidemiology; D011300:Preoperative Care; D011446:Prospective Studies; D011871:Radiology; D012121:Respiration, Artificial; D012769:Shock / Q000453:epidemiology; D017592:Skin Care; D015300:Ventilator Weaning; D014839:Vomiting / Q000453:epidemiology; D028761:Withholding Treatment