Effect of saline 0.9% or Plasma-Lyte 148 therapy on feeding intolerance in patients receiving nasogastric enteral nutrition.
OBJECTIVE
To compare the effect of Plasma-Lyte (PL)-148 and saline 0.9% (saline) on gastrointestinal (GI) feeding intolerance in mechanically ventilated patients receiving nasogastric (NG) feeding in an intensive care unit.


METHODS
A single-centre pilot study, nested within a multicentre, double-blind, cluster-randomised, double-crossover trial, performed in a mixed medical and surgical ICU.


METHODS
All adult patients who required crystalloid fluid therapy as part of the 0.9% Saline versus Plasma-Lyte 148 for Intensive Care Unit Fluid Therapy (SPLIT) trial, were expected to need mechanical ventilation for more than 48 hours and were receiving enteral nutrition exclusively by NG tube were eligible. We enrolled 69 patients and assigned 35 to PL-148 and 34 to saline.


METHODS
We randomly allocated saline or PL-148 for four alternating 7-week blocks, with staff blinded to the solution.


METHODS
The primary outcome was the proportion of patients with GI feeding intolerance, defined as high gastric residual volume (GRV), diarrhoea or vomiting while receiving NG feeding in the ICU. The proportions of patients with each of high GRV, diarrhoea and vomiting were secondary outcomes.


RESULTS
In the PL-148 group, 21 of 35 patients (60.0%) developed GI feeding intolerance, compared with 22 of 34 patients (64.7%) in the saline group (odds ratio [OR], 0.82; 95% CI, 0.31-2.17; P = 0.69). A high GRV was seen in four of 35 patients (11.4%) in the PL-148 group, and in 11 of 34 patients (32.4%) in the saline group (OR, 0.27; 95% CI, 0.08-0.96; P = 0.04).


CONCLUSIONS
Among mechanically ventilated patients receiving NG feeding, the use of PL-148, compared with saline, did not reduce the proportion of patients developing GI feeding intolerance, but was associated with a decreased incidence of high GRV.
Medical Research Institute of New Zealand, Wellington, New Zealand. sumeetkreddy@gmail.com.
Sumeet
S
Reddy
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Michael
M
Bailey
Medical Research Institute of New Zealand, Wellington, New Zealand.
Richard
R
Beasley
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
Rinaldo
R
Bellomo
Medical Research Institute of New Zealand, Wellington, New Zealand.
Diane
D
Mackle
Intensive Care Unit, Wellington Regional Hospital, Wellington, New Zealand.
Alex
A
Psirides
Medical Research Institute of New Zealand, Wellington, New Zealand.
Paul
P
Young
D000328:Adult; D000368:Aged; D003422:Critical Care; D018592:Cross-Over Studies; D000077324:Crystalloid Solutions; D004311:Double-Blind Method; D004750:Enteral Nutrition; D005260:Female; D005440:Fluid Therapy; D005767:Gastrointestinal Diseases / Q000628:therapy*; D005942:Gluconates; D006801:Humans; D007441:Intubation, Gastrointestinal; D007552:Isotonic Solutions / Q000627:therapeutic use*; D015636:Magnesium Chloride; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011189:Potassium Chloride; D012121:Respiration, Artificial; D019346:Sodium Acetate; D012965:Sodium Chloride
D000077324:Crystalloid Solutions; D005942:Gluconates; D007552:Isotonic Solutions; C012499:Plasma-lyte 148; D015636:Magnesium Chloride; D012965:Sodium Chloride; D019346:Sodium Acetate; D011189:Potassium Chloride