Evaluation of the provision of enteral nutrition in critically ill patients receiving mechanical ventilation

Meike Mayasari, Fella Farikhatul Mahmudah, Silviana Perwitasari, Umi Rahayu



Background: Providing enteral nutrition to ICU patients is often challenging, leading to sufficient enteral nutrition that is hardly achieved. This condition is caused by gastrointestinal motility disorder and other complications that often happen during enteral nutrition provision. Therefore, it is important to understand the level of nutritional support and the challenges in the form of interruption during enteral nutrition to critically ill patients receiving mechanical ventilation to optimise the benefit of nutritional support for patients, including reducing the duration of hospitalisation and mortality.

Objectives: This study aims to evaluate the provision of enteral nutrition and identify the cause of interruption for patients with mechanical ventilation in one of the tertiary hospitals in Yogyakarta, Indonesia who receive enteral nutrition.

Methods: This is a cross-sectional study. The subject of the study is patients who fulfil the inclusion and exclusion criteria. Inclusion criteria include patients who were in ICU for ≥72 hours, receiving mechanical ventilation. While the exclusion criteria include patients with contraindications for enteral nutrition such as unstable haemodynamic, bowel obstruction, persistent severe ileus, gastrointestinal bleeding, nasogastric tube (NGT) placement is not possible, patients receiving oral nutrition with non-invasive ventilation, patients with feeding tube before admission, or patients from other ICU or HCU.

Results: Patients needed, on average, 13 hours to receive initial enteral nutrition (SD ± 9.89 hours), with a period between 0 – 50 hours since admission to ICU. The mean time for patients to receive full feeding is 4 days ± 2.4 days. On the other hand, 16 out of 75 patients (21.2%) did not reach the targeted intake during admission. The cause of the interruption of enteral nutrition includes gastric residual volume (GRV), percutaneous dilatation tracheostomy (PDT) procedure, vomiting, bloating, surgery, CT scan, etc.

Conclusion: Many causes of interruption and inadequate intake of enteral nutrition can be prevented. The absence of protocol agreed upon by the patient care team could be one of the influencing factors.

KEYWORD:  enteral nutrition; enteral nutrition interruption; mechanical ventilation



enteral nutrition; enteral nutrition interruption; mechanical ventilation

Full Text:



Mahan LK, Raymond JL. 2017. Food & Nutrition Care Process. Missouri: Elsevier Inc

Btaiche IF, Chan LN, Pleva M, Kraft MD. Critical illness, gastrointestinal complications, and medication therapy during enteral feeding in critically ill adult patients. Nutr Clin Pract. 2010;25(1):32-49.

Reintam A, Parm P, Kitus R, Kern H, Starkopf J. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand. 2009;53:318-324.

Adam S, Batson S. A study of problems associated with the delivery of enteral feed in critically ill patients in five ICUs in the UK. Intensive Care Med. 1997;23:261-266

Heyland D, Cook DJ, Winder B, Brylowski L, Van deMark H, Guyatt G. Enteral nutrition in the critically ill patient: a prospective survey. Crit Care Med. 1995;23:1055-1060.

Kim H, Stotts NA, Froelicher ES, Engler MM, Porter C: Enteral nutritional intake in adult Korean intensive care patients. Am J Crit Care Off Publ Am Assoc Crit-Care Nurses 2013, 22(2):126–135.

Compton F, Bojarski C, Siegmund B, Giet MVD. Use of a Nutrition Support Protocol to Increase Enteral Nutrition Delivery in Critically Ill Patients. Am J Crit Care 2014;23:396-403

Heyland DK, Cahill NE, Dhaliwal R, et al. Impact of enteral feeding protocols on enteral nutrition delivery: results of a multicenter observational study. JPEN J Parenter Enteral Nutr 2010;34:675-84.

Mackenzie SL, Zygun DA, Whitmore BL, Doig CJ, Hameed SM: Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit. JPEN J Parenter Enteral Nutr 2005, 29(2):74–80.

Peev MP, Yeh DD, Quraishi SA, Osler P, Chang Y, Gillis E, Albano CE, Darak S, Velmahos GC: Causes and consequences of interrupted enteral nutritional prospective observational study in critically ill surgical patients. Journal of Parenteral and Enteral Nutrition 2014, 39 (1): 21–27

Bauer ZA, De Jesus O, Bunin JL 2021. Unconscious Patient. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan. 2021 Jun 5. https://pubmed.ncbi.nlm.nih.gov/30860764/

Hamonangan, Akhyar. Incidence of Loss of Conciousness in Critically Ill Patients refeed to Anesthesiologist in Emergency Department. International Journal of Innovative Science and Research Technology Volume 4, Issue 6, June – 2019

Shebi Eman, Bracken Burns. StatPearls [Internet]. StatPearls Publishing: 29 July 2021. Respiratory Failure.

Roussos, C., & Koutsoukou, A. (2003). Respiratory failure. European Respiratory Journal, 22(Supplement 47), 3s-14s. doi:10.1183/09031936.03.00038503

O'Meara D, Cabodevila EM, Frame F, Hummell AC, Hammel J, Dweik RA, Arroliga AC.Evaluation of Delivery of Enteral Nutrition in Critically Ill Patients Receiving Mechanical Ventilation. 2008. American Journal of Critical Care 17(1):53-61

Yip KF, Rai V and Wong KK. Evaluation of delivery of enteral nutrition in mechanically ventilated Malaysian ICU patients. BMC Anesthesiology 2014, 14:127

Tatsumi, hiroomi. 2019. Enteral tolerance in ctitically ill patients. Tatsumi Journal of Intensive Care (2019) 7:30 https://doi.org/10.1186/s40560-019-0378-0

Allen K, Hoffamn L. Enteral Nutrition in the Mechanically Ventilated Patient. Nutrition in Clinical Practice Volume 00 Number 0 xxxx 2019 1–18

Heyland DK, Stephens KE, Day AG, et al. The success of enteral nutrition and ICU-acquired infections: a multicenter observational study. Clin Nutr. 2011;30:148–55

Kozar, R. A., McQuiggan, M. M., Moore, E. E., Kudsk, K. A., Jurkovich, G. J., & Moore, F. A. (2002). Postinjury Enteral Tolerance Is Reliably Achieved by a Standardized Protocol. Journal of Surgical Research, 104(1), 70–75. doi:10.1006/jsre.2002.6409 .

Kim, H; Stotts, N.A; Froelicher, E. S; Engler, M.M; Porter, C; Kwak, H. 2012. J Clin Nurs. 2012 October ; 21(0): 2860–2869. doi:10.1111/j.1365-2702.2012.04218.x

Rice TW, Swope T, Bozeman S, Wheeler AP: Variation in enteral nutrition delivery in mechanically ventilated patients. Nutr (Burbank Los Angeles County Calif) 2005, 21(7–8):786–792.

Kim H, Shin JA, Shin JY, Cho OM. Adequacy of nutritional support and reasons for underfeeding in neurosurgical intensive care unit patients. Asian Nursing Research. 2010; 4:102–110. [PubMed: 25030950].

Uozumi M , Sanui M, Komuro T, Lizuka Y, Kamio T, Koyama H, Mouri H, Masuyama T, Ono K and Lefor AK. Interruption of enteral nutrition in the intensive care unit: a single-center survey. Journal of Intensive Care (2017) 5:52

Wang, Z., Ding, W., Fang, Q., Zhang, L., Liu, X., & Tang, Z. (2019). Effects of Not Monitoring Gastric Residual Volume in Intensive Care Patients: A Meta-Analysis. International Journal of Nursing Studies. doi:10.1016/j.ijnurstu.2018.11.005

McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., Gervasio, J. M., Sacks, G. S., Roberts, P. R. dan Compher, C. (2016) “Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.),” Journal of Parenteral and Enteral Nutrition. John Wiley & Sons, Ltd, 40(2), hal. 159–211. doi: 10.1177/0148607115621863

Gayatri, A.-J., Megan, N., Ching-Tat, L., Elizabeth, N., Donna, G., Karen, S., & Sanjay, P. (2020). Composition of Coloured Gastric Residuals in Extremely Preterm Infants-A Nested Prospective Observational Study. Nutrients, 12(9), 2585. doi:10.3390/nu12092585

Barr J, Hecht M, Flavin KE, Khorana A, Gould MK. Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. Chest. 2004; 125(4):1446–1457. [PubMed: 15078758]

Lottes, Stewart, M. (2014). Nutrition Support Protocols and Their Influence on the Delivery of Enteral Nutrition: A Systematic Review. Worldviews on Evidence-Based Nursing, 11(3), 194–199. doi:10.1111/wvn.12036

Doig GS, Simpson F, Finfer S, et al. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. JAMA 2008;300:2731-41. [Crossref] [PubMed

Pirlich M. 2016. Approach to Oral and Enteral Nutrition in Adults. Germany: ESPEN LLL Programme

DOI: http://dx.doi.org/10.21927/ijnd.2023.11(1).30-39


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Indonesian Journal of Nutrition and Dietetics (IJND) indexed by:


Lisensi Creative Commons View My Stats