Enteral Feeding Intolerance
Conditions
Keywords
plasma glucose levels,, enteral feeding intolerance, enteral feeding methods, sepsis
Brief summary
Comparison of the effects of bolus, intermittent and continuous enteral feeding techniques on plasma glucose level and enteral feeding intolerance in adult intensive care unit patients with sepsis.
Detailed description
in this prospective, controlled trial the main aim is to evaluate the effects of bolus, intermittent and continuous enteral feeding techniques on plasma glucose level in intensive care patients with sepsis diagnosis and to determine whether they are superior to each other in providing norma-glycemia. The secondary aim is to determine the effect of these 3 different enteral feeding techniques on enteral feeding intolerance.
Interventions
OTHERenteral feeding
The amount of enteral nutrition that should be given daily was calculated by the nutritionist using the Harris-Benedict formula. Formula at room temperature was given with a nasogastric foley catheter and a feeding pump. The position of the nasogastric Foley catheter in the stomach was confirmed by the PAAC graph when it was first inserted, and by listening before each feeding. Feeding was done in a position with the head at 30 degrees.
PROCEDUREblood glucose measurements
Blood glucose values were measured in all groups at 06:00, 12:00, 18:00 and 24:00, 4 times a day for 7 days. The sample was taken from the patient's cannula and examined in the biochemistry lab. The targeted range in the measurements was accepted as 70-180 mg/dl.
PROCEDUREEvaluation of feeding intolerance with gastric residue
gastric residue assessment; 30 minutes after the feeding was stopped, the N/G tube was drained and the amount coming 30 minutes later was evaluated. Residue positive was defined as the return of more than half of the amount of formula in the last cycle. The same was continued without increasing the amount given. If the incoming amount was less than half, the residue was evaluated as negative and the formula was continued by increasing the predetermined amount.
Sponsors
Umraniye Education and Research Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SCREENING
Masking
DOUBLE (Subject, Outcomes Assessor)
Masking description
Limitation of the study; since the patients were intubated and under sedation, they did not know the diet applied to them, but the physician/nurse who examined the residue and PGD knew the diet. Unfortunately, the person who evaluated these two parameters could not be blinded, as it would not be possible to give without showing the feeding methods. However, groups 1-2-3 were reported to the statistician who analyzed the data. The feeding methods of the groups was not reported.
Intervention model description
If the patients were diagnosed with sepsis in ICU, they were not fed after 24:00, and if the gastric residual measured at 05:00 in the morning was negative, they were included in the study. The patients were examined in 3 groups. The number of samples required to be taken in the power analysis performed (G\*power 3.1) was found to be 93 (31 patients in each group) (power value 0.80, alpha error probability=0.05). Patients for the groups were randomly selected by the closed envelope method. A total of 93 envelopes, 31 for each group, were prepared. When the patient was diagnosed with sepsis, if he/she met the inclusion criteria, a random envelope was selected to determine the patient's group. After inclusion in the study, a closed envelope was added again for the patients who should be excluded from the study.
Eligibility
Sex/Gender
ALL
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
* Hospitalized in ICU for more than 3 days * Ages between 18-70 years * APACHI II is in the range of 8-25 * BMI in the range of 18.5-30 * Able to receive enteral nutrition from N/G * Intubated on ventilator support * No previous diagnosis of Diabetes Mellitus, * Those who have not had Gastro intestinal System surgery in the last 6 months * Patients not receiving inotropic support * not receiving hemodiafiltration * No history of allergy to the food used * Patients with a focus of infection and/or culture-positive patients diagnosed with sepsis according to Q SOFA (cultures were taken from all patients)
Exclusion criteria
* patient's death during the study * Taking more than 40 mg of IV steroids daily * Increased baseline APACHI II score * Development of the patient's need for inotropes * Elimination of inclusion criteria * negative culture
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| effect of enteral feeding methods on blood glucose levels | for 7 days after the start of feeding | Evaluation of hypo/hyperglycemia development by measuring blood glucose level 4 times a day |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| feeding intolerance | during the 7th day with the start of feeding | effect on feeding intolerance, detection of more than half of the feeding amount will be taken as gastric residue positive so intolerance positive |
Countries
Turkey (Türkiye)
Outcome results
None listed