Need For Feeds: Early Enteral Feeding In Mechanically Ventilated, Critically Ill Patients

SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Current guidelines recommend early enteral nutrition during critical illness within 24 to 48 hours of admission. The purpose of our study was to investigate the percent of patients admitted to our medical ICU (MICU) who received enteral nutrition within 48 hours of mechanical ventilation and to investigate barriers to administering optimal enteral nutrition. METHODS: We conducted a single-center, retrospective chart review of patients over the age of 18 who were admitted to the MICU in our academic community hospital in New York, NY and mechanically ventilated between July 1, 2019 and November 30, 2019. Patients who had nasogastric or percutaneous endoscopic gastrostomy feeding tubes placed prior to intubation, patients with tracheostomies, and those intubated for fewer than 48 hours were excluded. Contraindications to tube feeds were based on the ESICM 2017 clinical practice guidelines. An anonymous, electronic survey of internal medicine resident physicians was conducted to assess perception and knowledge of enteral feeding. RESULTS: Of 128 patients, 63 were excluded, the majority excluded due to length of intubation less than 48 hours. The average age of the included 65 patients was 68 years, 55% (36/65) male and 45% (29/65) female. The three most common admitting diagnoses were sepsis or septic shock 26% (17/65), respiratory failure 25% (16/65), and EtOH withdrawal 8% (5/65), Three patients had contraindications to tube feeds. Of the 62 included patients without contraindications to tube feeds, 85% (53/62) were started on tube feeds at any time and 61% (38/62) were started on tube feeds within 48 hours, and 15% (9/62) were not. Thirty of about ninety residents responded to the survey, of whom 77% (23/30) were “somewhat confident” starting tube feeds and only 13% (4/30) felt “confident in all aspects.” The reasons for not beginning enteral nutrition were lack of knowledge about correct formula 48% (14/30), timing of nutrition 45% (13/30), which patients require enteral nutrition 38% (11/30), and placing a nasogastric or orogastric tube 7% (2/30). CONCLUSIONS: Sixty-one percent of mechanically ventilated patients in our MICU were started on enteral feeds within 48 hours of intubation. Survey results from resident physicians suggest lack of knowledge and confidence as barriers to beginning enteral nutrition. Our survey was limited in sample size and in low survey response rate. CLINICAL IMPLICATIONS: This study demonstrates that many mechanically ventilated patients receive suboptimal enteral nutrition. In contrast to current literature, our study was limited to mechanically ventilated patients. Practitioner education and implementation of MICU nutrition protocol on admission would allow for improved guideline adherence and increase rates of enteral feeding. DISCLOSURES: No relevant relationships by Zein Kattih, source=Web Response no disclosure on file for linda kirschenbaum; No relevant relationships by Rebecca Mazurkiewicz, source=Web Response No relevant relationships by Rebecca Zweifler, source=Web Response