Effects of standard versus energy dense feeds on gastric retention, calorie delivery, and glycaemia in critically ill patients

Chapple LS1,2, Summers MJ1,2, Weinel L1,2, Ali Abdelhamid Y1,3, Kar P1, Calnan D4, Hatzinikolas S5, Lange K5, Poole A1, O’Connor S2, Horowitz M5, Jones KL5, Deane A3,5, Chapman M1,2.

1Discipline of Acute Care Medicine, University of Adelaide, 2Intensive Care Unit, Royal Adelaide Hospital, CALHN, SA Health, 3Intensive Care Unit, The Royal Melbourne Hospital, Victoria, 4Nuclear Medicine, Royal Adelaide Hospital, CALHN, SA Health, 5Discipline of Medicine, University of Adelaide

 

Background: Critically ill patients frequently exhibit delayed gastric emptying and associated feed intolerance, which are frequently managed by the prescription of energy-dense formulae. However, these formulae have a higher lipid content and may delay gastric emptying (GE) further.

Aim: To compare the rate of GE of isocaloric 1 and 2 kcal/ml liquid nutrient boluses in critically ill patients.

Methods: A randomised, blinded, cross-over study was performed in mechanically ventilated adults on two consecutive days following a four hour fast. They received an isocaloric, radiolabeled, intragastric bolus of either 200ml of a 1kcal/ml or 100ml of a 2kcal/ml enteral formula. GE was measured using scintigraphy. Total areas under the curve from baseline to 120 minutes (AUC120) were determined for gastric retention and small intestinal calorie delivery. Group differences were compared using a paired mixed effects model. Data are presented as mean ± SE.

Results: Fifteen patients were studied (M:F 11:4; age 55.9 ± 5.9 years). There was no difference in the rate of GE (AUC120: 1 kcal/ml 5640±524 vs 2 kcal/ml 7009±745 %.min; p=0.059) or gastric retention at 120 mins (16.8±3.7 vs 31.4±9.5; mean difference 14.6 (95% CI -6.2, 35.4); p=0.147). There was no difference in small intestinal calorie delivery (AUC120: 13078 (1048) vs 9527 (1501) kcal; p=0.057) or calorie delivery per unit time (AUC120: 172±25 vs 153±26 kcal/min.120min; p=0.513).

Conclusion: In critically ill adults, does not appear to markedly augment calorie delivery to the small intestine.


Matt is a Research Dietitian who has been working within the ICU Research team for over 10 years. Matt completed his undergraduate Bachelor of Science majoring in nutrition in 2007 and commenced a Research Scientist role within ICU Research shortly thereafter. A few years later Matt undertook a Master of Dietetics, graduating in 2014.

Matt’s research interests include nutrient absorption in critically ill patients, as well as nutritional intake and outcomes following ICU stay. In addition to research experience in ICU, Matt has experience as a clinical dietitian in the outpatient setting as well as dietitian experience in the elite team sport environment.

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