SCCM Podcast SCCM Pod-437 Enteral Feeding Intolerance in the Mechanically Ventilated Critically Ill
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May 11, 2021 Darren Hyland, Director of the Clinical Evaluation Research Unit at Kingston General Hospital and an expert in critical care medicine, discusses enteral feeding intolerance in mechanically ventilated patients. He highlights the prevalence of this issue and its severe impact on nutrition and patient outcomes. The conversation dives into the debate over gastric residual volumes, the role of prokinetic agents, and how medications can alter gastric motility. Strategies for optimizing nutrition and the importance of tailored feeding protocols are also explored, ensuring critically ill patients receive the best care.
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Incidence And Early Timing
- Enteral feeding intolerance occurs in roughly 25–33% of ICU patients and typically appears early, around day 4–5.
- It is associated with lower nutrition delivery and worse outcomes including higher mortality and longer length of stay.
Feeding Intolerance Predicts Poor Outcomes
- Patients with enteral feeding intolerance receive less nutrition and have worse clinical outcomes including increased mortality and fewer ventilator-free days.
- The odds of dying are about 1.5 times greater for patients who develop enteral feeding intolerance.
Nutrition Risk Determines Impact
- Not all ICU patients have the same nutritional risk; missing 10% of intake may matter only in high-risk patients.
- Trials mixing low- and high-risk patients obscure benefits of optimized nutrition, so risk stratification matters.