Does diarrhoea diagnosis cause an interruption in enteral nutrition delivery in the ICU – Retrospective audit

Background: Infective diseases, pharmaceutical causes, and enteral nutrition (EN) delivery are commonly blamed for diarrhoea in critically ill patients. Reduction or cessation of EN is common after diarrhoea diagnosis, however there is insufficient data to show the extent of this issue in Australian Intensive Care Units (ICUs).

Aim: To investigate the impact of diarrhoea diagnosis on enteral feed delivery in ICU. Secondary outcomes included documented EN rate changes, and associated medication changes after diarrhoea diagnosis.

Method: This single-centre retrospective audit collected data on medical ICU patients who were coded by the Hospital's Health Information Systems Department for ‘diarrhoea’ and ‘mechanical ventilation >72 h. Data related to nutrition intervention and requirements, medication provision, and time of diarrhoea diagnosis were collected from the electronic medical record.

Results: Twenty-seven patients were included in the final analysis (mean age 60 years, 59% male). EN delivery before diarrhoea diagnosis met 76% of energy and 80% of protein requirements, however after diagnosis, provision of energy dropped to 61% (p = 0.128) of requirements and protein to 60% (p = 0.055). Documentation of change in EN delivery was observed in 33% (n = 6) of cases, with dietitian involvement evident for one patient.

Conclusions: Diarrhoea diagnosis caused a reduction in energy and protein delivery with inconsistent management and documentation observed. Further investigation is required, including consideration of a bowel management protocol, to improve EN delivery in the presence of diarrhoea. Background infective diseases, pharmaceutical causes, and enteral nutrition (EN) delivery are commonly blamed for diarrhoea.