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Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study

Hyunjung Kim
Korean Journal of Adult Nursing 2013;25(4):444-453.
Published online: August 18, 2013

Division of Nursing ‧ Research Institute of Nursing Science, Hallym University, Chuncheon, Korea

Corresponding author: Kim, Hyunjung Division of Nursing, Hallym University, 1 Hallymdaehak-gil, Chuncheon, 200-702, Korea. Tel: +82-33-248-2712, Fax: +82-33-248-2734, E-mail: hjkim97@hallym.ac.kr
• Received: March 6, 2013   • Accepted: August 13, 2013

© 2013 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 describe the differences between early and delayed enteral nutrition on nutritional intake.
  • Methods
    A pilot cohort study was conducted with 45 critically ill adult patients who had a primary medical diagnosis. Energy prescribed and received were collected during the four days after initiation of enteral nutrition. Adequate feeding was defined as the energy intake more than 90% of required energy.
  • Results
    A total of 23 patients (52%) were received early enteral nutrition (within 48 hours of admission). Energy intake of early enteral nutrition was less than intake of delayed enteral nutrition during the four days of the study. Although the difference on day one was significantly greater than the differences on day two, the differences on day two were not different from days three or four. No statistical differences in the adequacy of nutritional intake were found between patients in the early and the delayed group.
  • Conclusion
    In critically ill patients receiving early enteral nutrition, more aggressive administration from the beginning will improve the nutritional intake. Additional studies including a large multi-centre, randomized clinical trial are recommended.
  • Key Words: Early enteral nutrition; Intensive care units; Nutritional intake
Figure 1.
Trend in daily energy intake of early and delayed enteral nutrition
kjan-25-444f1.jpg
Table 1.
Characteristics of Participants (N=45)
Characteristics Categories Early nutrition (n=23) Delayed nutrition (n=22) x2 or t p
n (%) or M±SD n (%) or M±SD
Age(year)   71.7±13.8 66.1±15.0 1.29 .203
≤54 2 (8.7) 5 (22.7) 2.74 .601
55~64 4 (17.4) 3 (13.6)
65~74 5 (21.7) 6 (27.3)
75~84 9 (39.1) 7 (31.8)
≥85 3 (13.1) 1 (4.6)
Gender Male 9 (39.1) 13 (59.1) -0.20 .189
Female 14 (60.9) 9 (40.9)
Diagnosis Gastrointestinal 0 (0.0) 2 (9.1) -0.21 .158
Neurological 13 (56.5) 9 (40.9)
Sepsis 1 (4.3) 2 (9.1)
Renal 3 (13.1) 3 (13.6)
Respiratory 6 (26.1) 6 (27.3)
APACHE II score   11.2±5.6 15.6±6.0 -2.50 .016
Serum albumin (mg)   3.4±0.8 3.2±0.6 -0.16 .875
Serum CRP (mg)   3.7±5.0 7.1±7.2 -1.78 .082
BMI Underweight (＜18.5) 2 (8.7) 2 (9.1) -0.04 .804
Healthy weight (18.5~22.9) 8 (34.8) 8 (36.4)
Over weight (23~24.9) 8 (34.8) 6 (27.3)
Mild obese (25~25.9) 5 (21.7) 6 (27.3)
Feeding tube location Nasogastric tube 23 (100.0) 22 (100.0) - -
Feeding tube size 16 Fr 12 (52.2) 12 (54.5) -0.02 .877
18 Fr 11 (47.8) 10 (45.5)
Feeding formula Isocaloric 20 (87.0) 15 (68.2) 2.29 .130
Calorically dense 3 (13.0) 7 (31.8)
Prokinetics No 20 (87.0) 17 (77.3) 0.55 .458
Yes 3 (13.0) 5 (22.7)
Gastric residual Low(＜50) 17 (73.9) 14 (63.6) 0.75 .477
High(≥50ml) 6 (26.1) 8 (36.4)
Diarrhea No 18 (78.2) 12 (54.5) 3.52 .061
Yes 5 (21.8) 10 (45.5)
Vomiting No 22 (95.6) 20 (90.9) 1.89 .169
Yes 1 (4.4) 2 (9.1)

APACHE II=acute physiology chronic health evaluation II; CRP=C-reactive protein; BMI=body mass index.

Table 2.
Interaction between Energy received in the Early and Delayed Nutrition Group and Time (N=45)
Variables Categories Early nutrition (n=23) Delayed nutrition (n=22) Between group Within group
Group Time Time×Group
M±SD (kcal) M±SD (kcal) F (p)† F (p)† F (p)†
Energy received (total) Day1 714±236 1,203±422 13.89 (.001) 0.90 (.455) 5.59 (.004)
Day2 921±282 1,122±402
Day3 1,132±189 1,136±243
Day4 1,075±263 1,160±242
Mean 958±161 1,165±189
Energy received (enteral) Day1 548±124 893±201 4.54 (.041) 1.71 (.187) 2.60 (.057)
Day2 854±234 1,003±259
Day3 1,103±177 1,071±236
Day4 1,075±263 1,116±237
Mean 892±160 1,012±178
Energy required   1,228±230 1,377±317

†Controlling for APACHE II scores.

Table 3.
Comparison of Under- and Adequate Feeding in the Early and Delayed Enteral Nutrition Group (N=45)
Variables Early nutrition (n=23) Delayed nutrition (n=22) x2† p
n (%) n (%)
Underfeeding 17 (73.9) 11 (50.0) 2.76 .089
Adequate feeding 6 (26.1) 11 (50.0)    

†Controlling for APACHE II scores.

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    Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study
    Korean J Adult Nurs. 2013;25(4):444-453.   Published online August 31, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.4.444
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    Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study
    Korean J Adult Nurs. 2013;25(4):444-453.   Published online August 31, 2013
    DOI: https://doi.org/10.7475/kjan.2013.25.4.444
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    Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study
    Image
    Figure 1. Trend in daily energy intake of early and delayed enteral nutrition

    Figure 1.

    Nutritional Intake and Timing of Initial Enteral Nutrition in Intensive Care Patients: A Pilot Study

    Characteristics of Participants (N=45)

    Characteristics Categories Early nutrition (n=23) Delayed nutrition (n=22) x2 or t p
    n (%) or M±SD n (%) or M±SD
    Age(year)   71.7±13.8 66.1±15.0 1.29 .203
    ≤54 2 (8.7) 5 (22.7) 2.74 .601
    55~64 4 (17.4) 3 (13.6)
    65~74 5 (21.7) 6 (27.3)
    75~84 9 (39.1) 7 (31.8)
    ≥85 3 (13.1) 1 (4.6)
    Gender Male 9 (39.1) 13 (59.1) -0.20 .189
    Female 14 (60.9) 9 (40.9)
    Diagnosis Gastrointestinal 0 (0.0) 2 (9.1) -0.21 .158
    Neurological 13 (56.5) 9 (40.9)
    Sepsis 1 (4.3) 2 (9.1)
    Renal 3 (13.1) 3 (13.6)
    Respiratory 6 (26.1) 6 (27.3)
    APACHE II score   11.2±5.6 15.6±6.0 -2.50 .016
    Serum albumin (mg)   3.4±0.8 3.2±0.6 -0.16 .875
    Serum CRP (mg)   3.7±5.0 7.1±7.2 -1.78 .082
    BMI Underweight (＜18.5) 2 (8.7) 2 (9.1) -0.04 .804
    Healthy weight (18.5~22.9) 8 (34.8) 8 (36.4)
    Over weight (23~24.9) 8 (34.8) 6 (27.3)
    Mild obese (25~25.9) 5 (21.7) 6 (27.3)
    Feeding tube location Nasogastric tube 23 (100.0) 22 (100.0) - -
    Feeding tube size 16 Fr 12 (52.2) 12 (54.5) -0.02 .877
    18 Fr 11 (47.8) 10 (45.5)
    Feeding formula Isocaloric 20 (87.0) 15 (68.2) 2.29 .130
    Calorically dense 3 (13.0) 7 (31.8)
    Prokinetics No 20 (87.0) 17 (77.3) 0.55 .458
    Yes 3 (13.0) 5 (22.7)
    Gastric residual Low(＜50) 17 (73.9) 14 (63.6) 0.75 .477
    High(≥50ml) 6 (26.1) 8 (36.4)
    Diarrhea No 18 (78.2) 12 (54.5) 3.52 .061
    Yes 5 (21.8) 10 (45.5)
    Vomiting No 22 (95.6) 20 (90.9) 1.89 .169
    Yes 1 (4.4) 2 (9.1)

    APACHE II=acute physiology chronic health evaluation II; CRP=C-reactive protein; BMI=body mass index.

    Interaction between Energy received in the Early and Delayed Nutrition Group and Time (N=45)

    Variables Categories Early nutrition (n=23) Delayed nutrition (n=22) Between group Within group
    Group Time Time×Group
    M±SD (kcal) M±SD (kcal) F (p)† F (p)† F (p)†
    Energy received (total) Day1 714±236 1,203±422 13.89 (.001) 0.90 (.455) 5.59 (.004)
    Day2 921±282 1,122±402
    Day3 1,132±189 1,136±243
    Day4 1,075±263 1,160±242
    Mean 958±161 1,165±189
    Energy received (enteral) Day1 548±124 893±201 4.54 (.041) 1.71 (.187) 2.60 (.057)
    Day2 854±234 1,003±259
    Day3 1,103±177 1,071±236
    Day4 1,075±263 1,116±237
    Mean 892±160 1,012±178
    Energy required   1,228±230 1,377±317

    †Controlling for APACHE II scores.

    Comparison of Under- and Adequate Feeding in the Early and Delayed Enteral Nutrition Group (N=45)

    Variables Early nutrition (n=23) Delayed nutrition (n=22) x2† p
    n (%) n (%)
    Underfeeding 17 (73.9) 11 (50.0) 2.76 .089
    Adequate feeding 6 (26.1) 11 (50.0)    

    †Controlling for APACHE II scores.
    Table 1. Characteristics of Participants (N=45)

    APACHE II=acute physiology chronic health evaluation II; CRP=C-reactive protein; BMI=body mass index.

    Table 2. Interaction between Energy received in the Early and Delayed Nutrition Group and Time (N=45)

    Controlling for APACHE II scores.

    Table 3. Comparison of Under- and Adequate Feeding in the Early and Delayed Enteral Nutrition Group (N=45)

    Controlling for APACHE II scores.

    Table 1.

    Table 2.

    Table 3.

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