| Abstract: Aim : Enteral nutrition (EN) is often used in critically ill patients. Gastrointestinal intolerance is the most important factor limiting its use. Our objective was to evaluate the relationship between EN tolerance and intra-abdominal pressure (IAP).
Patients and methods: A total of 42 patients admitted to the intensive care unit and receiving EN were enrolled prospectively: 32 had medical diseases and 10 had abdominal surgery. AlI patients were fol1owed until discharge or death in the ICU. APACHE II score, IAP and sagittal abdominal diameter (SAD) were recorded at admission. Every six hours the fol1owing were recorded: IAP , SAD, ml/h of administered diet, diarrhea, vomiting of the EN formula, high gastric residuals, need for temporary stop of the infusion, use of benzodiadiazepines, opiates and prokinetic agents
Results: The mean first IAP recording before commencing EN was 7.10 3.4 mmHg.. Patients with medical conditions had an initial IAP of 6.12 . 9 mmHg; in the surgical patients it was 10.1.3.1 mmHg (P=0,001). High gastric residuals (58%), diarrhea (28%) and vomiting (12%) were the main gastrointestinal complications. The patients with good tolerance to EN (n=23) had a mean IAP of5.12 3 mmHg whereas those with one or more episodes of intolerance (n=19) had a mean IAP of 8.8 .2.1 mmHg (P<0.001). When EN had to be stopped because of intolerance, a mean IAP of 10,4 1.8 mmHg was recorded, while in patients fed continuously it was 5.12. 3 mmHg (P<0.001).In patients with episode(s) of intolerance (n=19), the mean IAP was of6.7 1.9 mmHg at the time the EN wasn't stopped and, in patients with good tolerance throughout, the mean IAP was 5.12.3 mrnHg (P=0,02). The volume flow of EN was 39.9. 18.9 mL/h in patients whose IAP was >10 mmHg at any time vs. 61.9 17.6 mL/h in those whose IAP remained always <10 mmHg (p<0.001). 12 patients died (28.6%). The mean IAP was 8.3 2.8 mmHg in non-survivors and 6.22. 6 mmHg in survivors (P=0,03); 11 patients died among the 19 who intolerated EN compared with only 1 death among the 23 patients in whom EN was successful1y administered (p<0.001).
Discussion: In critically ill patients there is an inverse relationship between tolerance to EN and IAP .EN intolerance has a prognostic value in these patients. IAP measurements in critically ill patients receiving EN can be used to monitor diet tolerance and for prognostic assessment. |
