title: Prevalence, risk factors, clinical consequences, and treatment of enteral feed intolerance during critical illness.
abstract: BACKGROUND
  We aimed to determine the incidence of enteral feed intolerance and factors associated with intolerance and to assess the influence of intolerance on nutrition and clinical outcomes.
  
  
  METHODS
  We conducted a retrospective analysis of data from an international observational cohort study of nutrition practices among 167 intensive care units (ICUs). Data were collected on nutrition adequacy, ventilator-free days (VFDs), ICU stay, and 60-day mortality. Intolerance was defined as interruption of enteral nutrition (EN) due to gastrointestinal (GI) reasons (large gastric residuals, abdominal distension, emesis, diarrhea, or subjective discomfort). Logistic regression was used to determine risk factors for intolerance and their clinical significance. A sensitivity analysis restricted to sites specifying a gastric residual volume ≥200 mL to identify intolerance was also conducted.
  
  
  RESULTS
  Data from 1,888 ICU patients were included. The incidence of intolerance was 30.5% and occurred after a median 3 days from EN initiation. Patients remained intolerant for a mean (±SD) duration of 1.9 ± 1.3 days . Intolerance was associated with worse nutrition adequacy vs the tolerant (56% vs 64%, P < .0001), fewer VFDs (2.5 vs 11.2, P < .0001), increased ICU stay (14.4 vs 11.3 days, P < .0001), and increased mortality (30.8% vs 26.2, P = .04). The sensitivity analysis demonstrated that intolerance remained associated with negative outcomes. Although mortality was greater among the intolerant patients, this was not statistically significant.
  
  
  CONCLUSIONS
  Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes.
authors.affiliation: Worldwide Epidemiology, Quantitative Sciences, GlaxoSmithKline R&D, Uxbridge, United Kingdom.
authors.forename: Usha
authors.initials: U
authors.lastname: Gungabissoon
authors.affiliation: Discovery Biometrics, Quantitative Sciences, GlaxoSmithKline R&D, Uxbridge, United Kingdom.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Hacquoil
authors.affiliation: Worldwide Epidemiology, Quantitative Sciences, GlaxoSmithKline R&D, Uxbridge, United Kingdom.
authors.forename: Chanchal
authors.initials: C
authors.lastname: Bains
authors.affiliation: Worldwide Epidemiology, Quantitative Sciences, GlaxoSmithKline R&D, Durham, North Carolina, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Irizarry
authors.affiliation: Academic DPU, GlaxoSmithKline R&D, Durham, North Carolina, USA.
authors.forename: George
authors.initials: G
authors.lastname: Dukes
authors.affiliation: II MDC, GlaxoSmithKline R&D, Uxbridge, United Kingdom.
authors.forename: Russell
authors.initials: R
authors.lastname: Williamson
authors.affiliation: Department of Critical Care Services, Royal Adelaide Hospital and the Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
authors.affiliation: Department of Medicine and Public Health Sciences, Queen's University, Kingston, Ontario, Canada Clinical Evaluation Research Unit at Kingston General Hospital, Kingston, Ontario, Canada dkh2@queensu.ca.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness / Q000401:mortality / Q000628:therapy*; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005746:Gastric Emptying; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D044342:Malnutrition / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D009752:Nutritional Status; D015995:Prevalence; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D005765:Gastrointestinal Agents
keywords: critical care; enteral nutrition; gastrointestinal function; motility agents; nutrition; nutrition adequacy; tolerance