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

Minju Lee; Jiyeon Kang

doi: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

Minju Lee¹, Jiyeon Kang²

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

DOI: https://doi.org/10.7475/kjan.2014.26.6.621

¹Kosin University Gaspel Hospital, SICU, Busan

²Department of Nursing, Dong-A University, Busan, Korea

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

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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Abstract
REFERENCES

Abstract

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

^†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)
Variables		M±SD	M±SD	M±SD	M±SD	M±SD	F (p)
Daily requirement (Kcal)		1624.17	1624.17	1624.17	1624.17	1624.17
Daily requirement (Kcal)		±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
Prescription rate (%)		(＜.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
Supply rate (%)		(＜.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
Variables	M±SD	M±SD	t	p
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
Variables	r (p)	r (p)
Nutritional supply rate	-0.20 (.239)	-0.37 (.021)

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3.McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition. 2009;33(3):277-316. http://dx.doi.org/10.1177/0148607109335234.
4.Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. The canadian critical care clinical practice guidelines committee. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult. Canadian clinical practice guidelines. Journal of Parenteral and Enteral Nutrition. 2009;27(5):355-73. http://dx.doi.org/10.1177/0148607103027005355.
5.Park YO, Kang EH, Park SJ, Park MA, Yoon SY, Kim SL, et al. A current survey of the gastric residual volume in critically ill patients who are receiving enteral nutrition. Journal of the Korean Society for Parental & Enteral Nutrition. 2009;2(1):24-9.
6.Park EKDegree of enteral tube feeding in the intensive care unit and change in nutritional status. [master's thesis]. Seoul: Yonsei University; 2000.
7.De Jonghe B, Appere-De-Vechi C, Fournier M, Tran B, Merrer J, Melchior JC, et al. A prospective survey of nutritional support practices in intensive care unit patients: what is prescribed? What is delivered? Critical Care Medicine. 2001;29(1):8-12.
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8.Park EK, Lee JH, Lim HS. Degree of enteral tube in the intensive care unit and change in nutritional status. Journal of the Korean Dietetic Association. 2001;7(3):217-26.
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10.Dobson K, Scott A. Review of ICU nutrition support practice: implementing the nurse-led enteral feeding algorithm. Nursing in Critical Care. 2007;12(3):114-23. http://dx.doi.org/10.1111/j.1478-5153.2007.00222.x.
11.Appelboam R, Sair M. Nutrition in the critically ill patient. Anaesthesia and Intensive Care Medicine. 2006;7(2):121-3.
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12.Bourgault AM, Ipe L, Weaver J, Swartz S, O'Dea PJ. Development of evidence-based guidelines and critical care nurses' knowledge of enteral feeding. Critical Care Nurse. 2007;27(4):17-29.
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13.Moon SS, Lim HS, Choi JW, Kim DK, Lee JW, Ko SH, et al. Analysis of nutritional support status in intensive care unit. The Korean Journal of Critical Care Medicine. 2009;24(3):129-33. http://dx.doi.org/10.4266/kjccm.2009.24.3.129.
14.Wo̸ien H, Bjo̸rk IT. Nutrition of the critically ill patient and effects of implementing a nutritional support algorithm in ICU. Journal of Clinical Nursing. 2006;15(2):168-77. http://dx.doi.org/10.1111/j.1365-2702.2006.01262.x.
15.NST Standardization Commission. Nutrition support guideline. Seoul: Korean Society for Parental & Enteral Nutrition; 2007.
16.Kim MEDevelopment of performance measures based in nursing process for fluid intake/output and tube care. Seoul: Hospital Nurses Association; 2011. p. 49-57.
17.Kim DSKnowledge, perception and performance on naso-gastric tube feeding in intensive care unit nurses. [master's thesis]. Wonju: Yonsei University; 2008.
18.Moon SSAnalysis of nutritional supporting status in intensive care unit. [master's thesis]. Jeonju: Chonbuk National University; 2008.
19.Heyland DK, Schroter-Noppe D, Drover JW, Jain M, Keefe L, Dhaliwal R, et al. Nutrition support in the critical care setting: current practice in Canadian ICUs-opportunities for improvement? Journal of Parenteral and Enteral Nutrition. 2003;27(1):74-83.
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Comparison of the nutritional indicators of critically Ill patients on extracorporeal membrane oxygen (ECMO)
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Journal of Nutrition and Health.2015; 48(3): 211. CrossRef

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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

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

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

Table 1.

Characteristics of the Participants (N=52)

Characteristics	Categories	n (%)	M±SD
Gender	Female	22 (42.3)
Gender	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
Characteristics	Categories	n (%)	n (%)	p
Mental status	Awaken^†	24 (46.2)	36 (69.2)	.002
Mental status	Asleep^‡	28 (53.8)	16 (30.8)	.002
Ventilator	Yes	15 (28.8)	9 (17.3)	.031
Ventilator	No	37 (71.2)	43 (82.7)	.031
Sedation	Yes	12 (23.1)	5 (9.6)	.016
Sedation	No	40 (76.9)	47 (90.4)	.016
Inotropics	Yes	15 (28.8)	4 (7.7)	.001
Inotropics	No	37 (71.2)	48 (92.3)	.001

^†

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)
Variables		M±SD	M±SD	M±SD	M±SD	M±SD	F (p)
Daily requirement (Kcal)		1624.17	1624.17	1624.17	1624.17	1624.17
Daily requirement (Kcal)		±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
Prescription rate (%)		(＜.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
Supply rate (%)		(＜.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
Variables	M±SD	M±SD	t	p
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
Variables	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;

#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)

^†

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)

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