Enteral nutrition therapy in intensive care units: a comparative study between prescribed and administered diet

Enteral nutritional therapy (ENT) has a solid and important role in the treatment of severely ill patients in ICUs. The multidisciplinary team therefore has to assure a safe nutritional therapy free from failures. The objectives of this study were to compare the prescribed and administrated volume of enteral diet; to compare daily caloric needs (DCN) with the prescribed calories (PC) and the administrated calories (AC); and to identify the factors associated with failures in the administration of enteral therapy. This is a descriptive, comparative and prospective study carried out in two general ICUs of a private hospital in the city of São Paulo, Brazil, in 2005. The data were collected daily based on information from medical records. Descriptive statistics as well as the Student t test, kappa rate and logistic regression model (stepwise forward) were used to analyze the data. P < 0.05 was considered statistically significant. The sample was composed of 61 patients (636 enteral diet daily administration). The time between the admission to the ICU and ENT was, on average, 2.5 days; most diets (57.6%) were special and were administered through an enteral catheter placed into the stomach (56.9%). The volume of diet administered was usually smaller than the prescribed one, respectively 1,111.8 ± 400.4 ml and 1,257.2 ± 306.9 ml (P = 0.000). Concerning calories, PC (1,302.6 ± 481.9) as well as AC (1,164.8 ± 508.2) were statistically smaller than the DCN (1,797.1 ± 292.7). The comparison between volume and calories according to the intervals showed a moderate concordance between the prescribed and administered volumes (kappa = 0.614) and low concordance between the DCN and PC (kappa = 0.191) and between the DCN and AC (kappa = 0.100). From a total of 308 reasons for failure while administering the prescribed volume, the wrong calculus of the infusion speed by the nursing team was predominant (20.8%) followed by diagnostic or therapeutic examinations and surgical procedures (14.9%); 70.6% of the reasons were avoidable. The factors associated with failure in volume administration were age, infusion speed and DCN. The results indicate the importance of further studies that look into adverse events related to the administration of enteral therapy aiming to guarantee the actual nutritional needs of severely ill patients in ICUs.