222 AMERICAN JOURNAL OF CRITICAL CARE, May 2005, Volume 14, No. 3 • B A CKGR OUND Inadequate nutritional intake in critically ill patients can lead to complications result- ing in increased mortality and healthcare costs. Several factors limit adequate nutritional intake in intensive care unit patients given enteral feedings. • O BJECTIVE To examine the adequacy of enteral nutritional intake and the factors that affect its deliv- ery in patients receiving mechanical ventilation. • M ETHODS A prospective, descriptive design was used to study 60 patients receiving enteral feedings at target or goal rate. Energy requirements were determined for the entire sample by using the Harris- Benedict equation; energy requirements for a subset of 25 patients were also determined by using indi- rect calorimetry. Energy received via enteral feeding and reason and duration of interruptions in feedings were recorded for 3 consecutive days. • R ESUL TS Mean estimated energy requirements (8996 kJ, SD 1326 kJ) and mean energy intake received (5899 kJ, SD 3058 kJ) differed significantly (95% CI 3297-3787; P < .001). A total of 41 patients (68.3%) received less than 90% of their required energy intake, 18 (30.0%) received within ±10%, and 1 (1.7%) received more than 110%. Episodes of diarrhea, emesis, large residual volumes, feeding tube replacements, and interruptions for procedures accounted for 70% of the variance in energy received (P <.001). Procedural interruptions alone accounted for 45% of the total variance. Esti- mated energy requirements determined via indirect calorimetry and mean energy received did not differ. • C ONCLUSIONS Most critically ill patients receiving mechanical ventilation who are fed enterally do not receive their energy requirements, primarily because of frequent interruptions in enteral feedings. (American Journal of Critical Care. 2005;14:222-231) NUTRITIONAL ADEQUACY IN P ATIENTS RECEIVING MECHANICAL VENTILATION WHO ARE FED ENTERALLY To purchase reprints, contact The InnoVision Group, 101 Columbia, Aliso Viejo, CA 92656. Phone, (800) 809-2273 or (949) 362-2050 (ext 532); fax, (949) 362-2049; e-mail, reprints@aacn.org. By Colleen M. O’Leary-Kelley, RN, PhD, CCRN, Kathleen A. Puntillo, RN, DNSc, Juliana Barr, MD, Nancy Stotts, RN, EdD, and Marilyn K. Douglas, RN, DNSc. From Veterans Affairs Palo Alto Health Care System, Palo Alto, Calif (CMO, JB, MKD), Department of Physiological Nursing, University of California, San Fran- cisco, San Francisco, Calif (KAP, NS), and Stanford University School of Medicine, Stanford, Calif (JB). A dequate nutritional support is crucial in the prevention and treatment of malnutrition in critically ill patients. 1-3 Patients in the inten- sive care unit (ICU) who cannot take food orally require either enteral or parenteral nutritional support. Enteral nutrition is generally preferred over parenteral nutrition because the former is associated with a lower incidence of infectious and noninfectious com- plications, reduced cost, and a decreased length of hospital stay. 4-6 Despite these benefits, meeting the full nutritional requirements of critically ill patients by giving enteral feedings can be difficult. 7-9 Patients who CE O nline and Journal Club Feature To receive CE credit for this article, visit the American Association of Critical-Care Nurses’ (AACN) Web site at http://www.aacn.org, click on “Education” and select “Continuing Education,” or call AACN’s Fax on Demand at (800) 222-6329 and request item No. 1112. CE O nline by guest on January 27, 2016 ajcc.aacnjournals.org Downloaded from