title: The reasons for insufficient enteral feeding in an intensive care unit: A prospective observational study.
abstract: BACKGROUND
  Although enteral nutrition (EN) in critically ill patients is increasingly common, enteral underfeeding remains problematic. In the present study, we aimed to identify the reasons for insufficient EN.
  
  
  METHODS
  In this single-centre, prospective, observational study in a general intensive care unit, the nurses documented cases experiencing enteral underfeeding during three-month study period. Decisions regarding EN were made and substantiated by the doctors. No feeding protocol was in use. The EN rate was assessed daily and considered insufficient if less than 50 kcal/h was administered and the rate had not increase in the previous 12 hour period.
  
  
  RESULTS
  Eighty-seven patients were screened for 707 patient-days. Nurses documented 141 instances of insufficient EN in 49 patients (56.7% of all study subjects). EN was not initiated in 61% of these cases, EN was stopped in 14%, EN decreased in 2% and insufficient EN was not increased in 23%. EN was not initiated primarily due to surgical reasons. EN was not increased due to clinical instability. EN was decreased or stopped primarily due to high gastric residual volumes (GRV). The study served as step one in a quality improvement process and resulted in the introduction of a nurse-driven feeding protocol.
  
  
  CONCLUSIONS
  The main reasons for insufficient EN in intensive care patients include recent GI surgery, shock and large GRV. EN is commonly withheld for several days after GI surgery, whereas in shock there was a prohibition on increasing EN towards the target. Insufficient EN is highly prevalent; the incidence of EN should be reduced by training and the acceptance of more liberal EN policies.
authors: General Intensive Care Unit, Tartu University Hospital, Tartu, Estonia.
authors: Maarja
authors: M
authors: Kuslapuu
authors: General Intensive Care Unit, Tartu University Hospital, Tartu, Estonia.
authors: Krista
authors: K
authors: Jõgela
authors: General Intensive Care Unit, Tartu University Hospital, Tartu, Estonia; Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
authors: Joel
authors: J
authors: Starkopf
authors: Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia. Electronic address: annika.reintam.blaser@ut.ee.
authors: Annika
authors: A
authors: Reintam Blaser
mesh_terms: D002985:Clinical Protocols; D064648:Critical Care Nursing; D013505:Digestive System Surgical Procedures / Q000706:statistics & numerical data*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D006801:Humans; D007362:Intensive Care Units; D044342:Malnutrition / Q000453:epidemiology*; D011446:Prospective Studies; D012307:Risk Factors; D012769:Shock / Q000453:epidemiology*
keywords: Enteral nutrition; Gastrointestinal surgery; Intensive care; Underfeeding