question for Enteral experts based on Dr Drover's case study

[blueeysedRN]

Our hospital is reviewieng our formulary and conisdering using a
1.5cal/ml fiber tube feeding product as our standard house formula in
order to meet patient nutritional goals faster and to ensure that
adequate feeding is given.

There is much discussion on whether or not one needs a 1.o cal/ml
enteral feeding.

I am wondering if you experts would consider this an appropriate
practice if fluid balance is monitored and a smaller volume of feeding
was initially started then progressed.

In reviewing the total TF volumes given per day--we noticed when we
used the 1.0 cal/ml products-many patients did not meet their goal
rates until day 4-5. In Dr Drover's comments below, I notice that he
gave smaller volume of a higher calorically dense feeding in some of
the critical care patients.

Any comments or input would be greatly appreciated

[Drover, Dr. John W.]

I would have to say it is not completely clear what the correct
concentration of formula should be. As the history of enteral nutrition
products has evolved it has been convenient to have them mixed in a
solution of 1 cal/ml. This formulation allows fluid requirements to be
met at the same time that nutrition is being delivered.

I do not think there is a specific problem with delivering more caloric
the dense formulas. However, my experience with these formulas is that
there are greater difficulties with free water deficits. In the ICU this
often shows up in the longer stay patients as hypernatremia. When this
occurs they are often treated by administering additional free water and
this should usually mean moving back to a more dilute enteral feed.
Therefore, although you may move towards a more calorically dense
formula on a regular basis you will still need the more dilute formulas
for giving adequate fluid to some patients.

You may be correct, it may be easier to reach goal targets for caloric
delivery with more concentrated solution. You're also correct that the
fluid and electrolyte balance in these patients must be monitored
carefully.

Respectfully,

John W. Drover, MD, FACS, FRCSC
Associate Professor
Chair and Program Medical Director
Critical Care Program
Queen's University
Davies 2
Kingston General Hospital
76 Stuart Street
Kingston, Ontario
Canada
K7L 2V7
Phone 613-549-6666 ext 6335
Fax 613-548-2480

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[Merin Kinikini]

I would be cautious with regards to the fiber in critically ill patients, otherwise I think the 1.5 cal formula works fine for a standard formula as long as total free water needs are assessed.

Merin

-----Original Message-----
From: criticalca...@googlegroups.com [mailto:criticalca...@googlegroups.com] On Behalf Of blueeysedRN
Sent: Wednesday, December 14, 2011 9:21 AM
To: Critical Care Nutrition
Subject: [Critical Care Nutrition] question for Enteral experts based on Dr Drover's case study

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