UCSF

Background: Underfeeding is a common and severe problem for critically ill patients receiving enteral nutrition. There are many factors contributing to inadequate enteral nutrition intake in patients hospitalized in the intensive care unit (ICU). Little is known about the factors that impact adequacy of nutritional intake in Korean patients.

Objectives: This dissertation aimed to describe the adequacy of enteral nutritional intake and identify factors that impact adequate intake in critically ill patients receiving enteral nutrition. A particular focus was on identifying the contribution of the factors that had an impact on the adequacy of energy intake in the first four days after the initiation of enteral feeding in critically ill Korean patients.

Methods: The first paper was a literature review regarding barriers to adequate enteral nutritional intake. The second and third papers report data from a prospective cohort study. Data were collected from 34 critically ill adult patients hospitalized in the Korean medical ICU who were receiving bolus enteral nutrition. The data on nutritional intake, feeding methods, and feeding interruptions were recorded from medical records during the first four days after enteral feeding initiation.

Findings: The first paper demonstrated that under-prescription, late initiation, frequent interruptions of enteral nutrition and gradual progression of the feeding administration rate were barriers to adequate enteral intake. Nutrient-dense formulas and transpyloric feeding were associated with increased energy intake. The second paper showed that most critically ill Korean patients were underfed with enteral nutrition. Under-prescription, prolonged interruptions of enteral nutrition, and early initiation were associated with underfeeding in critically ill Korean patients. The third paper demonstrated that enteral nutritional intake was consistently insufficient across all four days. Prolonged feeding interruptions due to GI intolerance and procedures were the major contributors to inadequate nutritional intake in critically ill Korean patients. The findings suggest that healthcare providers awareness and knowledge of enteral nutrition should be improved. Standardized feeding protocols should be developed, tested, and implemented to provide adequate nutritional support to the critically ill.