Abstract
Objective
To assess the relationship between blood glucose concentrations (BSL) and intolerance to gastric feeding in critically ill patients.
Design
Prospective, case-controlled study.
Patients and participants
Two-hourly BSL and insulin requirements over the first 10 days after admission were assessed in 95 consecutive feed-intolerant (NG aspirate > 250 ml during feed) critically ill patients and 50 age-matched, feed-tolerant patients who received feeds for at least 3 days. Patients with diabetes mellitus were excluded. A standard insulin protocol was used to maintain BSL at 5.0–7.9 mmol.
Measurements and results
The peak BSLs were significantly higher before and during enteral feeding in feed-intolerant patients. The mean and trough BSLs were, however, similar between the two groups on admission, 24 h prior to feeding and for the first 4 days of feeding. The variations in BSLs over 24 h before and during enteral feeding were significantly greater in feed-intolerant patients. A BSL greater than 10 mmol/l was more prevalent in patients with feed intolerance during enteral feeding. The time taken to develop feed intolerance was inversely related to the admission BSL (r = –0.40). The amount of insulin administered before and during enteral feeding was similar between the two groups.
Conclusions
Feed intolerance in critically ill patients is associated with a greater degree of glycaemic variation, with a greater number of patients with transient hyperglycaemia. These data suggest more intensive insulin therapy may be required to minimize feed intolerance, an issue that warrants further study.
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Supported by the National Health and Medical Research Council of Australia.
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Nguyen, N., Ching, K., Fraser, R. et al. The relationship between blood glucose control and intolerance to enteral feeding during critical illness. Intensive Care Med 33, 2085–2092 (2007). https://doi.org/10.1007/s00134-007-0869-7
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DOI: https://doi.org/10.1007/s00134-007-0869-7