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Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients

Minju Lee1, Jiyeon Kang2
Korean Journal of Adult Nursing 2014;26(6):621-629.
Published online: December 31, 2014

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Corresponding author: Kang, Jiyeon Department of Nursing, Dong-A University, 1 Dongdaesin-dong 3-ga, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2871, Fax: +82-51-240-2920, E-mail: jykang@dau.ac.kr
• Received: July 1, 2014   • Accepted: November 25, 2014

Copyright © 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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  • Purpose
    The purpose of this study was to investigate the nutritional support, gastric residual volume, and nutritional status of the intensive care unit (ICU) patients on enteral feeding.
  • Methods
    A descriptive longitudinal design was used to collect 5 day data on enteral nutrition of 52 ICU patients in an university hospital. Nutritional support was calculated with actual caloric intake compared to individual caloric requirement. Residual volumes were measured prior to routine feedings, and the serum albumin levels and the total lymphocyte counts were checked to evaluate nutritional status. The data were analyzed using one group repeated measures ANOVA, paired t-test, and Spearman's bivariate correlation analysis.
  • Results
    The subjects received their first enteral feeding on the 5.75th day of ICU admission. The mean nutritional support rate was 49.1% of the requirement, however prescription rate and support rate were increased as time goes by. Gastric residual volumes were less than 10 cc in 95% cases. A significant negative correlation was found between nutritional support and nutritional status.
  • Conclusion
    The nutritional support for ICU patient was low compared to the requirement, and their nutritional status was worse than at the time of ICU admission. Further studies are necessary to develop nursing interventions for improving nutritional support for ICU patients.
  • Key Words: Intensive care units; Patient; Enteral nutrition; Nutritional support; Nutritional status
Table 1.
Characteristics of the Participants (N=52)
Characteristics Categories n (%) M±SD
Gender Female 22 (42.3)  
Male 30 (57.7)
Age (year) 65.50±14.04
Affiliated department Neurosurgery 16 (30.8)  
Neurology 12 (23.1)
Pulmonary 9 (17.3)
Nephrology 6 (11.5)
Others† 9 (17.3)
Admission route Emergency room 39 (75.0)  
  Inpatient unit 13 (25.0)
APACHE III score     63.17±22.92
Duration of ICU stay (day)     16.63±11.47
First day of enteral nutrition (since ICU admission)     5.75±3.90
Use of TPN Yes 40 (76.9)  
  No 12 (23.1)  
Duration of enteral nutrition (day)     8.15±7.48
Reason for termination of survey Discharge from ICU 28 (53.8)  
Change to oral feeding 13 (25.0)
NPO 11 (21.2)

APACHE III score=acute physiology and chronic health evaluation III score; ICU=intensive care units; TPN=total parenteral nutrition; NPO=nothing by mouth;

#x2020;Infectious disease, Cardiology, Hepatology, General surgery, Cardiothoracic surgery.

Table 2.
Clinical Characteristics of Subjects on ICU Admission Day and the First Day of Entral Nutrition (N=52)
Characteristics Categories Admission day First day of nutrition p
n (%) n (%)
Mental status Awaken† 24 (46.2) 36 (69.2) .002
Asleep‡ 28 (53.8) 16 (30.8)
Ventilator Yes 15 (28.8) 9 (17.3) .031
No 37 (71.2) 43 (82.7)
Sedation Yes 12 (23.1) 5 (9.6) .016
No 40 (76.9) 47 (90.4)
Inotropics Yes 15 (28.8) 4 (7.7) .001
No 37 (71.2) 48 (92.3)

†Ramsay sedation score 1~3;

‡Ramsay sedation score 4~6.

Table 3.
Changes of Daily Nutritional Support of the Subjects (N=32)
Variables Day 1 Day 2 Day 3 Day 4 Day 5 F (p)
M±SD M±SD M±SD M±SD M±SD
Daily requirement (Kcal)   1624.17 1624.17 1624.17 1624.17 1624.17  
±430.74 ±430.74 ±430.74 ±430.74 ±430.74
Daily prescribed amount (Kcal) 521.88 765.63 881.25 985.94 1031.25 15.88
±320.01 ±307.55 ±344.95 ±330.01 ±370.21 (＜.001)‡
t (p) 12.66 9.75 8.26 7.00 5.74  
(＜.001)† (＜.001)† (＜.001)† (＜.001)† (＜.001)†
Daily supplied amount (Kcal) 496.88 734.38 850.00 879.69 1025.00 16.01
±328.72 ±344.18 ±352.87 ±409.54 ±379.30 (＜.001)‡
t (p) 13.32 9.92 7.66 6.06 5.68  
(＜.001)† (＜.001)† (＜.001)† (＜.001)† (＜.001)†
Prescription rate (%) 33.4±24.3 49.5±23.4 56.7±25.6 63.7±25.3 67.2±28.8 12.84
(＜.001)‡
Supply rate (%) 31.4±24.3 47.2±25.2 55.5±26.8 58.9±30.3 66.9±29.2 13.13
(＜.001)‡

†Compared with daily requirement (paired t-test);

‡Comparison by time (One group repeated measure ANOVA).

Table 4.
Comparison of Nutritional Status of Subjects at the Time of ICU Admission and during ICU Stay (N=52)
Variables Admission day Average value during ICU stay t p
M±SD M±SD
Albumin (g/dL) 3.58±0.69 3.04±0.48 5.76 ＜.001
Total lymphocyte count (nm) 1745.45±1419.91 1233.56±715.22 2.15 .038

ICU=intensive care units.

Table 5.
Correlation between Nutritional Support and Nutritional Status (N=52)
Variables Changes of albumin Changes of total lymphocyte
r (p) r (p)
Nutritional supply rate -0.20 (.239) -0.37 (.021)
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    Korean J Adult Nurs. 2014;26(6):621-629.   Published online December 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.6.621
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    Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
    Korean J Adult Nurs. 2014;26(6):621-629.   Published online December 31, 2014
    DOI: https://doi.org/10.7475/kjan.2014.26.6.621
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    Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
    Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients

    Characteristics of the Participants (N=52)

    Characteristics Categories n (%) M±SD
    Gender Female 22 (42.3)  
    Male 30 (57.7)
    Age (year) 65.50±14.04
    Affiliated department Neurosurgery 16 (30.8)  
    Neurology 12 (23.1)
    Pulmonary 9 (17.3)
    Nephrology 6 (11.5)
    Others† 9 (17.3)
    Admission route Emergency room 39 (75.0)  
      Inpatient unit 13 (25.0)
    APACHE III score     63.17±22.92
    Duration of ICU stay (day)     16.63±11.47
    First day of enteral nutrition (since ICU admission)     5.75±3.90
    Use of TPN Yes 40 (76.9)  
      No 12 (23.1)  
    Duration of enteral nutrition (day)     8.15±7.48
    Reason for termination of survey Discharge from ICU 28 (53.8)  
    Change to oral feeding 13 (25.0)
    NPO 11 (21.2)

    APACHE III score=acute physiology and chronic health evaluation III score; ICU=intensive care units; TPN=total parenteral nutrition; NPO=nothing by mouth;

    #x2020;Infectious disease, Cardiology, Hepatology, General surgery, Cardiothoracic surgery.

    Clinical Characteristics of Subjects on ICU Admission Day and the First Day of Entral Nutrition (N=52)

    Characteristics Categories Admission day First day of nutrition p
    n (%) n (%)
    Mental status Awaken† 24 (46.2) 36 (69.2) .002
    Asleep‡ 28 (53.8) 16 (30.8)
    Ventilator Yes 15 (28.8) 9 (17.3) .031
    No 37 (71.2) 43 (82.7)
    Sedation Yes 12 (23.1) 5 (9.6) .016
    No 40 (76.9) 47 (90.4)
    Inotropics Yes 15 (28.8) 4 (7.7) .001
    No 37 (71.2) 48 (92.3)

    Ramsay sedation score 1~3;

    Ramsay sedation score 4~6.

    Changes of Daily Nutritional Support of the Subjects (N=32)

    Variables Day 1 Day 2 Day 3 Day 4 Day 5 F (p)
    M±SD M±SD M±SD M±SD M±SD
    Daily requirement (Kcal)   1624.17 1624.17 1624.17 1624.17 1624.17  
    ±430.74 ±430.74 ±430.74 ±430.74 ±430.74
    Daily prescribed amount (Kcal) 521.88 765.63 881.25 985.94 1031.25 15.88
    ±320.01 ±307.55 ±344.95 ±330.01 ±370.21 (＜.001)‡
    t (p) 12.66 9.75 8.26 7.00 5.74  
    (＜.001)† (＜.001)† (＜.001)† (＜.001)† (＜.001)†
    Daily supplied amount (Kcal) 496.88 734.38 850.00 879.69 1025.00 16.01
    ±328.72 ±344.18 ±352.87 ±409.54 ±379.30 (＜.001)‡
    t (p) 13.32 9.92 7.66 6.06 5.68  
    (＜.001)† (＜.001)† (＜.001)† (＜.001)† (＜.001)†
    Prescription rate (%) 33.4±24.3 49.5±23.4 56.7±25.6 63.7±25.3 67.2±28.8 12.84
    (＜.001)‡
    Supply rate (%) 31.4±24.3 47.2±25.2 55.5±26.8 58.9±30.3 66.9±29.2 13.13
    (＜.001)‡

    Compared with daily requirement (paired t-test);

    Comparison by time (One group repeated measure ANOVA).

    Comparison of Nutritional Status of Subjects at the Time of ICU Admission and during ICU Stay (N=52)

    Variables Admission day Average value during ICU stay t p
    M±SD M±SD
    Albumin (g/dL) 3.58±0.69 3.04±0.48 5.76 ＜.001
    Total lymphocyte count (nm) 1745.45±1419.91 1233.56±715.22 2.15 .038

    ICU=intensive care units.

    Correlation between Nutritional Support and Nutritional Status (N=52)

    Variables Changes of albumin Changes of total lymphocyte
    r (p) r (p)
    Nutritional supply rate -0.20 (.239) -0.37 (.021)
    Table 1. Characteristics of the Participants (N=52)

    APACHE III score=acute physiology and chronic health evaluation III score; ICU=intensive care units; TPN=total parenteral nutrition; NPO=nothing by mouth;

    Infectious disease, Cardiology, Hepatology, General surgery, Cardiothoracic surgery.

    Table 2. Clinical Characteristics of Subjects on ICU Admission Day and the First Day of Entral Nutrition (N=52)

    Ramsay sedation score 1~3;

    Ramsay sedation score 4~6.

    Table 3. Changes of Daily Nutritional Support of the Subjects (N=32)

    Compared with daily requirement (paired t-test);

    Comparison by time (One group repeated measure ANOVA).

    Table 4. Comparison of Nutritional Status of Subjects at the Time of ICU Admission and during ICU Stay (N=52)

    ICU=intensive care units.

    Table 5. Correlation between Nutritional Support and Nutritional Status (N=52)

    Table 1.

    Table 2.

    Table 3.

    Table 4.

    Table 5.

    Korean J Adult Nurs : Korean Journal of Adult Nursing

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