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Managing Diarrhea During Enteral Feeding in ICU

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Diet and Nutrition in Critical Care

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Abstract

Diarrhea is common in the critically ill, and in enterally fed patients the tube feeding formula is frequently blamed for causing this. This blame is misplaced in many cases. There may be a variety of contributing causes, including medications, infection or disturbed gut flora, or the effect of critical illness itself on gut motility. The best management strategy is a consistent protocol-driven multidisciplinary approach. Diarrhea imposes additional costs and risks upon the critically ill and this burden is often unnecessary and manageable.

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Abbreviations

FODMAPs:

Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols

ICU:

Intensive care unit

SOFA:

Sequential organ failure assessment

References

  • American Gastroenterological Association Patient Care Committee. American Gastroenterological Association technical review on tube feeding for enteral nutrition. Gastroenterology. 1995;108(4):1282–301.

    Article  Google Scholar 

  • Basse L, Madsen JL, Kehlet H. Normal gastrointestinal transit after colonic resection using epidural analgesia, enforced oral nutrition and laxative. Br J Surg. 2001;88(11):1498–500.

    Article  CAS  PubMed  Google Scholar 

  • Belknap DC, Davidson LJ, Flournoy DJ. Microorganisms and diarrhea in enterally fed intensive care unit patients. J Parenter Enteral Nutr. 1990;14(6):622–8.

    Article  CAS  Google Scholar 

  • Belknap D, Davidson LJ, Smith CR. Diarrhea with enteral feedings. The effect of psyllium hydrophilic mucilloid on diarrhea in enterally fed patients. Heart Lung. 1997;26(3):229–37.

    Article  CAS  PubMed  Google Scholar 

  • Bhatia V, Tandon R. Stress and the gastrointestinal tract. J Gastroenterol Hepatol. 2005;20(3):332–9.

    Article  PubMed  Google Scholar 

  • Bleichner G, Blehaut H, Mentec H, Moyse D. Saccharomyces boulardii prevents diarrhea in critically ill tube-fed patients: a multicenter, randomized, double-blind placebo-controlled trial. Intensive Care Med. 1997;23:517–23.

    Article  CAS  PubMed  Google Scholar 

  • Borlase BC, Bell SJ, Lewis EJ, et al. Tolerance to enteral tube feeding diets in hypoalbuminaemic critically ill, geriatric patients. Surg Gynecol Obstet. 1992;174(3):181–8.

    CAS  PubMed  Google Scholar 

  • Carey SK, Ferrie S. Intestinal failure. In: Berhardt LV, editor. Advances in medicine and biology. 23rd ed. New York: Nova Publishers; 2011. ISBN 978-1-61209-703-9.

    Google Scholar 

  • Davies GJ, Crowder M, Reid M, et al. Bowel function measurements of individuals with different eating patterns. Gut. 1986;27:164–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • De Schryver AM, Keulemans YC, Peters HP, et al. Effects of regular physical activity on defecation pattern in middle-aged patients complaining of chronic constipation. Scand J Gastroenterol. 2005;40(4):422–9.

    Article  PubMed  Google Scholar 

  • Exton-Smith AN, Bendall MJ, Kent F. A new technique for measuring the consistency of faeces: a report on its application to the assessment of Senokot therapy in the elderly. Age Ageing. 1974;3:1–3.

    Article  Google Scholar 

  • Ferrie S, Daley M. Lactobacillus GG as treatment for diarrhoea during enteral feeding in critical illness: randomized controlled trial. J Parenter Enteral Nutr. 2011;35(1):43–9.

    Article  Google Scholar 

  • Ferrie S, East V. Managing diarrhoea in intensive care. Aust Crit Care. 2007;20(1):7–13.

    Article  PubMed  Google Scholar 

  • Fraser RJ, Ritz M, Di Matteo AC, et al. Distal small bowel motility and lipid absorption in patients following abdominal aortic aneurysm repair surgery. World J Gastroenterol. 2006;12(4):582–7.

    PubMed Central  PubMed  Google Scholar 

  • Freedland CP, Roller RD, Wolfe BM, Flynn NM. Microbial contamination of continuous drip feedings. J Parenter Enteral Nutr. 1989;13(1):18–22.

    Article  CAS  Google Scholar 

  • Gionchetti P, Lammers KM, Rizzello F, et al. Probiotics and barrier function in colitis. Gut. 2005;54:898–900.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Halmos EP, Muir JG, Barrett JS, Deng M, Shepherd SJ, Gibson PR. Diarrhoea during enteral nutrition is predicted by the poorly absorbed short-chain carbohydrate (FODMAP) content of the formula. Aliment Pharmacol Ther. 2010;32(7):925–33.

    Article  CAS  PubMed  Google Scholar 

  • Heimburger DC, Sockwell DG, Geels WJ. Diarrhea with enteral feeding: prospective reappraisal of putative causes. Nutrition. 1994;10(5):392–6.

    CAS  PubMed  Google Scholar 

  • Heimburger DC, Geels WJ, Thiesse KT, et al. Randomized trial of tolerance and efficacy of a small-peptide enteral feeding formula versus a whole-protein formula. Nutrition. 1995;11(4):360–4.

    CAS  PubMed  Google Scholar 

  • Hempel S, Newberry SJ, Maher AR, Wang Z, Miles JNV, Shanman R, Johnsen B, Shekelle PG. Probiotics for the prevention and treatment of antibiotic-associated diarrhea. A systematic review and meta-analysis. JAMA. 2012;307(18):1959–69.

    Article  CAS  PubMed  Google Scholar 

  • Homann H, Kemen M, Fuessenich C, et al. Reduction in diarrhea incidence by soluble fibre in patients receiving total or supplemental enteral nutrition. J Parenter Enteral Nutr. 1994;18(6):486–90.

    Article  CAS  Google Scholar 

  • Isolauri E, Sütas Y, Kankaanpää P, Arvilommi H, Salminen S. Probiotics: effects on immunity. Am J Clin Nutr. 2001;73(2 suppl):444S–50.

    CAS  PubMed  Google Scholar 

  • Jack L, Coyer F, Courtney M, Venkatesh B. Diarrhoea risk factors in enterally tube fed critically ill patients: a retrospective audit. Intensive Crit Care Nurs. 2010;26(6):327–34.

    Article  PubMed  Google Scholar 

  • Jain PK, McNaught CE, Anderson AD, et al. Influence of synbiotic containing Lactobacillus acidophilus La5, Bifidobacterium lactis Bb 12, Streptococcus thermophilus, Lactobacillus bulgaricus, and oligofructose on gut barrier function and sepsis in critically ill patients: a randomised controlled trial. Clin Nutr. 2004;23:467–75.

    Article  PubMed  Google Scholar 

  • Kandil HE, Opper FH, Switzer BR, et al. Marked resistance of normal subjects to tube-feeding-induced diarrhea: the role of magnesium. Am J Clin Nutr. 1993;57:73–80.

    CAS  PubMed  Google Scholar 

  • Klauser AG, Beck A, Schindlbeck NE, et al. Low fluid intake lowers stool output in healthy male volunteers. Z Gastroenterol. 1990;28(11):606–9.

    CAS  PubMed  Google Scholar 

  • Kohn CL. The relationship between enteral formula contamination and length of enteral delivery set usage. J Parenter Enteral Nutr. 1991;15(5):567–71.

    Article  CAS  Google Scholar 

  • Koizumi N, Fujii M, Ninomiya R, Inoue Y, Kagawa T, Tsukamoto T. Studies on transitory laxative effects of sorbitol and maltitol I: estimation of 50 % effective dose and maximum non-effective dose. Chemosphere. 1983;12(1):45–53.

    Article  CAS  Google Scholar 

  • Kraus K, Fanning J. Prospective trial of early feeding and bowel stimulation after radical hysterectomy. Am J Obstet Gynecol. 2000;182:996–8.

    Article  CAS  PubMed  Google Scholar 

  • Luft VC, Beghetto MG, de Mello ED, Polanczyk CA. Role of enteral nutrition in the incidence of diarrhea among hospitalized adult patients. Nutrition. 2008;24(6):528–35.

    Article  PubMed  Google Scholar 

  • Mobarhan S, DeMeo M. Diarrhea induced by enteral feeding. Nutr Rev. 1995;53(3):67–70.

    Article  CAS  PubMed  Google Scholar 

  • Mowatt-Larson CA, Brown RO, Wojtysiak SL, et al. Comparison of tolerance and nutritional outcome between a peptide and a standard enteral formula in critically ill, hypoalbuminaemic patients. J Parenter Enteral Nutr. 1992;16(1):20–4.

    Article  Google Scholar 

  • Nakamura S, Hongo R, Moji K, Oku T. Suppressive effect of partially hydrolyzed guar gum on transitory diarrhea induced by ingestion of maltitol and lactitol in healthy humans. Eur J Clin Nutr. 2007;61(9):1086–93.

    Article  CAS  PubMed  Google Scholar 

  • Nakao M, Ogura Y, Satake S, Ito I, Iguchi A, Takagi K, Nabeshima T. Usefulness of soluble dietary fiber for the treatment of diarrhea during enteral nutrition in elderly patients. Nutrition. 2002;18(1):35–9.

    Article  PubMed  Google Scholar 

  • Peters R, Lock RH. Laxative effect of sorbitol. Br Med J. 1958;2(5097):677–8.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Petrof EO, Dhaliwal R, Manzanares W, Johnstone J, Cook D, Heyland DK. Probiotics in the critically ill: a systematic review of the randomized trial evidence. Crit Care Med. 2012;40(12):3290–302.

    Article  PubMed  Google Scholar 

  • Powell M, Rigby D. Management of bowel dysfunction: evacuation difficulties. Nurs Stand. 2000;14(47):47–54.

    Article  CAS  PubMed  Google Scholar 

  • Rushdi TA, Pichard C, Khater YH. Control of diarrhea by fiber-enriched diet in the intensive care unit patients on enteral nutrition: a prospective randomized controlled trial. Clin Nutr. 2004;23(6):1344–52.

    Article  CAS  PubMed  Google Scholar 

  • Sanburg AL, McGuire TM, Lee T. Stepping out of constipation: an educational campaign. Aust J Hosp Pharm. 1996;26(3):350–5.

    Google Scholar 

  • Sanjoaquin MA, Appleby PN, Spencer EA, et al. Nutrition and lifestyle in relation to bowel movement frequency. Public Health Nutr. 2004;7(1):77–83.

    Article  PubMed  Google Scholar 

  • Schultz AA, Ashby-Hughes B, Taylor R, et al. Effects of pectin on diarrhea in critically ill tube-fed patients receiving antibiotics. Am J Crit Care. 2000;9(6):403–11.

    CAS  PubMed  Google Scholar 

  • Shankardass K, Chuchmach S, Chelswick K, et al. Bowel function of long-term tube-fed patients consuming formulae with and without dietary fiber. J Parenter Enteral Nutr. 1990;14(5):508–12.

    Article  CAS  Google Scholar 

  • Siitonen S, Vapaatalo H, Salminen S, et al. Effect of Lactobacillus GG yoghurt in prevention of antibiotic associated diarrhoea. Ann Med. 1990;22:57–9.

    Article  CAS  PubMed  Google Scholar 

  • Smith CE, Marien L, Brogdon C, et al. Diarrhea associated with tube feeding in mechanically ventilated critically ill patients. Nurs Res. 1990;39(3):148–52.

    Article  CAS  PubMed  Google Scholar 

  • Spapen H, Diltoer M, Van Malderen C, Opdenacker G, Suys E, Huyghens L. Soluble fiber reduces the incidence of diarrhea in septic patients receiving total enteral nutrition: a prospective, double-blind, randomized, and controlled trial. Clin Nutr. 2001;20(4):301–5.

    Article  CAS  PubMed  Google Scholar 

  • Timmerman HM, Niers LE, Ridwan BU, et al. Design of a multispecies probiotic mixture to prevent infectious complications in critically ill patients. Clin Nutr. 2007;26:450–9.

    Article  PubMed  Google Scholar 

  • Trabal J, Leyes P, Hervas S, Herrera M, de Tallo FM. Factors associated with nosocomial diarrhea in patients with enteral tube feeding. Nutr Hosp. 2008;23(5):500–4.

    CAS  PubMed  Google Scholar 

  • Tsunoda A, Shibusawa M, Takata M, et al. Early oral feeding should be resumed following the resolution of gastric ileus. Hepatogastroenterology. 2005;52(63):775–9.

    PubMed  Google Scholar 

  • World Health Organisation. Division of Diarrhoeal, Acute Respiratory Disease Control. The treatment of diarrhoea. A manual for physicians and other senior health workers. Geneva: World Health Organisation; 1990. p. 20–1.

    Google Scholar 

  • Yakobowich M. Prescribe with care: the role of laxatives in the treatment of constipation. J Gerontol Nurs. 1990;16(7):4–11.

    Article  Google Scholar 

  • Zimmaro D, Rolandelli R, Koruda M, et al. Isotonic tube feeding formula induces liquid stool in normal subjects: reversal by pectin. J Parenter Enteral Nutr. 1989;13(2):117–23.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Critical Care Dietitian, Intensive Care Service, Royal Prince Alfred Hospital, Missenden Road, 2050, Camperdown, NSW, Australia

    Suzie Ferrie

  2. Human Nutrition Unit, School of Molecular Bioscience, University of Sydney, Camperdown, NSW, Australia

    Suzie Ferrie

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  1. Suzie Ferrie
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Correspondence to Suzie Ferrie .

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Editors and Affiliations

  1. Department of Nutrition, King's College London, London, United Kingdom

    Rajkumar Rajendram

  2. School of Medicine, King's College London, London, United Kingdom

    Victor R. Preedy

  3. Department of Biomedical Sciences, University of Westminster, London, United Kingdom

    Vinood B. Patel

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Ferrie, S. (2014). Managing Diarrhea During Enteral Feeding in ICU. In: Rajendram, R., Preedy, V., Patel, V. (eds) Diet and Nutrition in Critical Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8503-2_10-1

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  • DOI: https://doi.org/10.1007/978-1-4614-8503-2_10-1

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  • Online ISBN: 978-1-4614-8503-2

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