Enteral nutrition feeding in Chinese intensive care units: a cross-sectional study involving 116 hospitals

Juan Xing, Zhongheng Zhang, Lu Ke, Jing Zhou, Bingyu Qin, Hongkai Liang, Xiaomei Chen, Wenming Liu, Zhongmin Liu, Yuhang Ai, Difeng Wang, Qiuhui Wang, Qingshan Zhou, Fusen Zhang, Kejian Qian, Dongpo Jiang, Bin Zang, Yimin Li, Xiaobo Huang, Yan Qu, Yinguang Xie, Donglin Xu, Zhiqiang Zou, Xiangde Zheng, Jianbo Liu, Feng Guo, Yafeng Liang, Qiang Sun, Hongmei Gao, Yang Liu, Ping Chang, Aibin Ceng, Rongli Yang, Gaiqi Yao, Yun Sun, Xiaorong Wang, Yi Zhang, Yichao Wen, Jian Yu, Rongqing Sun, Zhiwei Li, Shiying Yuan, Yunlin Song, Peiyang Gao, Haiyan Liu, Zhaohui Zhang, Yunfu Wu, Biao Ma, Qiang Guo, Feng Shan, Mingshi Yang, Hailing Li, Yuanfei Li, Weihua Lu, Lei Wang, Chuangyun Qian, Zhiyong Wang, Jiandong Lin, Rumin Zhang, Peng Wan, Zhiyong Peng, Yuqiang Gong, Linxi Huang, Guobao Wu, Jie Sun, Yijun Deng, Dongwu Shi, Lixin Zhou, Fachun Zhou, Qindong Shi, Xiaodong Guo, Xueyan Liu, Weidong Wu, Xiangzhong Meng, Liandi Li, Weiwei Chen, Shusheng Li, Xianyao Wan, Zhixin Chao, An Zhang, Liming Gu, Wei Chen, Jinglan Wu, Lihua Zhou, Zhenhuan Zhang, Yibing Weng, Yongshun Feng, Chunli Yang, Yongjian Feng, Sumin Zhao, Fei Tong, Dong Hao, Hui Han, Baocai Fu, Chuanyong Gong, Zhiping Li, Kunlin Hu, Qiuye Kou, Han Zhang, Jie Liu, Chuming Fan, Xin Zhou, Xiumei Chen, Junli Sun, Xuejun Zhou, Bin Song, Cheng Sun, Liyun Zhao, Xinglu Dong, Linlin Zhang, Dafei Tong, Zhiguo Pan, Chuangjie Cai, Donghao Wang, Yingjun Dong, Yuanqi Gong, Zhisong Wu, Xinke Meng, Ping Wang, Weiqin Li

There is a lack of large-scale epidemiological data on the clinical practice of enteral nutrition (EN) feeding in China. This study aimed to provide such data on Chinese hospitals and to investigate factors associated with EN delivery. This cross-sectional study was launched in 118 intensive care units (ICUs) of 116 mainland hospitals and conducted on April 26, 2017. At 00:00 on April 26, all patients in these ICUs were included. Demographic and clinical variables of patients on April 25 were obtained. The dates of hospitalization, ICU admission and nutrition initiation were reviewed. The outcome status 28 days after the day of investigation was obtained. A total of 1953 patients were included for analysis, including 1483 survivors and 312 nonsurvivors. The median study day was day 7 (IQR 2-19 days) after ICU entry. The proportions of subjects starting EN within 24, 48 and 72 h after ICU entry was 24.8% (84/352), 32.7% (150/459) and 40.0% (200/541), respectively. The proportion of subjects receiving > 80% estimated energy target within 24, 48, 72 h and 7 days after ICU entry was 10.5% (37/352), 10.9% (50/459), 11.8% (64/541) and 17.8% (162/910), respectively. Using acute gastrointestinal injury (AGI) 1 as the reference in a Cox model, patients with AGI 2-3 were associated with reduced likelihood of EN initiation (HR 0.46, 95% CI 0.353-0.599; p < 0.001). AGI 4 was significantly associated with lower hazard of EN administration (HR 0.056; 95% CI 0.008-0.398; p = 0.004). In a linear regression model, greater Sequential Organ Failure Assessment scores (coefficient - 0.002, 95% CI - 0.008 to - 0.001; p = 0.024) and male gender (coefficient - 0.144, 95% CI - 0.203 to - 0.085; p < 0.001) were found to be associated with lower EN proportion. As compared with AGI 1, AGI 2-3 was associated with lower EN proportion (coefficient - 0.206, 95% CI - 0.273 to - 0.139; p < 0.001). The study showed that EN delivery was suboptimal in Chinese ICUs. More attention should be paid to EN use in the early days after ICU admission.