Gastrointestinal dysfunction during enteral nutrition delivery in intensive care unit (ICU) patients: Risk factors, natural history, and clinical implications. A post-hoc analysis of The Augmented versus Routine approach to Giving Energy Trial (TARGET)

摘要

Background: Slow gastric emptying occurs frequently during critical illness and is roughly quantified at bedside by large gastric residual volumes (GRVs). A previously published trial (The Augmented versus Routine approach to Giving Energy Trial; TARGET) reported larger GRVs with energy-dense (1.5 kcal/mL) compared with standard (1.0 kcal/mL) enteral nutrition (EN). warranting further exploration. Objective: To assess the incidence, risk factors, duration, and timing of large GRVs (>= 250 mL) and its relation to clinical outcomes in mechanically ventilated adults. Methods: A post-hoc analysis of TARGET data in patients with >= 1 GRV recorded. Data are n () or median IQR. Results: Of 3876 included patients, 1777 (46) had >= 1 GRV >= 250 mL, which was more common in males (50 compared with 39; P = 250 mL were more likely to have the following: vasopressor administration (88 compared with 76; RR = 1.15 1.12, 1.19; P < 0.001), positive blood cultures (16 compared with 8; RR = 1.92 1.60. 2.31; P < 0.001), intravenous antimicrobials (88 compared with 81; RR = 1.09 1.06, 1.12; P < 0.001). and prolonged intensive care unit (ICU) stay (ICU-free days to day 28; 12.9 0.0-21.0 compared with 20.0 3.9-24.0; P < 0.001), hospital stay (hospital-free days to day 28: 0.0 0.0-12.0 compared with 7.0 0.0-17.6 d; P < 0.001), ventilatory support (ventilator-free days to day 28: 16.0 0.0-23.0 compared with 22.0 8.0-25.0; P < 0.001), and a higher 90-d mortality (29 compared with 23; adjusted: RR = 1.17 1.05. 1.30; P = 0.003). Conclusion: Large GRVs were more common in males and those receiving energy-dense formulae, occurred early and were shortlived, and were associated with a number of negative clinical sequelae, including increased mortality, even when adjusted for illness severity.