Preventing diarrhoea in enteral nutrition: the impact of the delivery set hang time.
BACKGROUND
To meet the current recommendations for enteral tube feeding (ETF), we updated our previous practice in 2011 and began to use a 24-h delivery set hang time (DSHT). We evaluated the impact of this update on the risk of diarrhoea and in diarrhoea-free survival.


METHODS
Observational, retrospective study with historical controls on ischaemic and haemorrhagic stroke patients undergoing ETF. Diarrhoea occurrence (≥ 3 liquid stools in 24 h) was compared between patients with a 24 h DSHT (2011-2014) and a 72/96 h DSHT (2010-2011). The analysis was conducted using Kaplan-Meier curves and a Cox regression model.


RESULTS
A total of 175 patients were included [median age 81 years (IQR = 12), 46.9% males], 103 in the group with a 24 h DSHT and 72 in the group with a 72/96 h DSHT. The group with a 24 h DSHT had a lower diarrhoea frequency (13.6% vs. 34.7%, risk ratio: 0.39, 95% CI: 0.22-0.70, p = 0.001) and a lower diarrhoea incidence rate (0.87 vs. 2.32 cases of diarrhoea/100 patient*day, rate ratio: 0.37, 95% CI: 0.19-0.72, p = 0.004). The Kaplan-Meier curves showed a longer diarrhoea-free survival for this group (p = 0.003, log-rank test). A 24 h DSHT was associated with a lower risk of diarrhoea (HR = 0.27, 95% CI: 0.12-0.61, p = 0.002), adjusted by albumin, stroke severity, intravenous thrombolysis, the administration of clindamycin and cefotaxime, and the administration of an enteral formula for diabetic patients.


CONCLUSIONS
The 24 h DSHT was independently associated with a lower risk of diarrhoea and longer diarrhoea-free survival in hospitalised patients with acute stroke under ETF, compared with a 72/96 h DSHT.
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Arevalo-Manso
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Martinez-Sanchez
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Juarez-Martin
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Fuentes
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Ruiz-Ares
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Sanz-Cuesta
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Parrilla-Novo
Department of Neurology and Stroke Centre, La Paz University Hospital, IdiPAZ, Hospital La Paz Institute for Health Research, Autonomous University of Madrid, Madrid, Spain.
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Diez-Tejedor
D000368:Aged; D000369:Aged, 80 and over; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012044:Regression Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy; D013997:Time Factors