A systematic review of the definitions and prevalence of feeding intolerance in critically ill adults

The term enteral feeding intolerance (FI) is frequently used in clinical practice and the literature, yet there is no standardised definition. FI is often quoted as a reason for failure to meet enteral nutrition (EN) targets but the lack of a consensus definition precludes accurate estimates of prev...

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Bibliographic Details
Published in:Clinical nutrition ESPEN 2022-06, Vol.49, p.92-102
Main Authors: Jenkins, Bethan, Calder, Philip C., Marino, Luise V.
Format: Article
Language:English
Subjects:
Adult
Case-Control Studies
Critical Care - methods
Critical illness
Critical Illness - epidemiology
Enteral Nutrition - methods
Feeding intolerance
Gastrointestinal Diseases - etiology
Humans
Infant, Newborn
Intensive care
Prevalence
Systematic review
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Summary:The term enteral feeding intolerance (FI) is frequently used in clinical practice and the literature, yet there is no standardised definition. FI is often quoted as a reason for failure to meet enteral nutrition (EN) targets but the lack of a consensus definition precludes accurate estimates of prevalence, predictors and clinical outcomes associated with FI. A systematic review was performed of studies in adult critical care patients to evaluate the definitions, relative risk, predictors and clinical outcomes of FI and to propose a uniform definition. Database searches were completed in MEDLINE Ovid, Embase, CINAHL, PsycINFO, Google Scholar, NHS Evidence, Scopus and Web of Science. The search was performed in January and February 2021. Studies were included if they had an interventional, observational cohort or case–control study design and contained a definition of FI in critically ill adults. The following data were extracted from each included article: 1) study design; 2) study objective; 3) inclusion criteria; 4) population and setting; 5) sample size; 6) definition of FI; 7) prevalence of FI; 8) predictors of FI; 9) clinical outcome measures associated with FI. Studies were grouped based on the symptoms used to define FI with random effects meta-analysis. 89 unique studies containing a definition of FI were identified. Studies were categorised according to definition of FI into 3 groups: 1) Gastric residual volume (GRV) and/or gastrointestinal (GI) symptoms (n = 74); 2) Ability to achieve EN target (n = 5); 3) Composite definitions (n = 10). Meta-analysis showed a relative risk of FI of 0.55 [95% CI 0.45, 0.68] (p 
ISSN:2405-4577
2405-4577
DOI:10.1016/j.clnesp.2022.04.014