Background

The objective of this cross-sectional study is:
1. To analyze most sensitive risk factors for aspiration in enterally fed patients
2. To identify clinically more efficient method of enteral feed administration (volume v/s rate based)
3. To compare efficacy of volume v/s rate based enteral feeds in terms of clinical and nutritional
outcomes

Methods

In first phase of this study (duration 4 months), an aspiration risk assessment scale was developed and administered on all patients (n=92) initiated on enteral feeds in the MICU. Using Fisher‘s Exact test, most sensitive factors for aspiration risk were identified. On the basis of which, in second phase, 48 patients (in the following period of 3 months) identified to have high and low risk of aspiration (≥3 and ≤2 most sensitive factors present)  were kept on rate based (n=25) and volume based (n=23) enteral feeding method respectively. Their clinical and nutritional outcomes were compared using Chi-Square test.

Results and Discussion

The Fisher‘s Exact test revealed delayed gastric emptying, increased gastric residual volume, reduced level of consciousness and ill oral health to be statistically significant factors (p <0.05) for aspiration risk. Comparative analysis of clinical outcomes in volume based v/s rate based enteral feeding showed average length of ventilation 3.66 and 4.03 days, ventilator free days being 4.00 and 3.68, ICU Length of stay (LOS) 7.67 and 7.77 days, total LOS 13.26 and 17.45 days
respectively.
Whilst comparison of nutritional outcomes depicted average percentage achieved calories 96.96% and 92.35%, percentage achieved protein 98.41% and 87.35% of nutritional requirements calculated using simplistic weight based equation, in volume based and rate based enteral feeding respectively. The average volume of feed provided per day was 1407.57ml and 1048.57ml, average hours of meeting up calorie and protein requirements were 55 and 62 for volume and rate based fed patients.

Conclusion

Aspiration risk assessment is fundamental in planning clinical care. In the absence of high risk factors of aspiration, patients may have better clinical and nutritional outcomes with volume based enteral feeding.