Association of enteral nutrition reduction or discontinuation with diarrhea volume and caloric delivery in critically ill adults with diarrhea: A retrospective cohort study.

Abstract

Background: When critically ill patients receiving enteral nutrition (EN) develop diarrhea, clinicians often reduce or discontinue EN, although evidence supporting this practice is limited. We examined the association between EN management after diarrhea and diarrhea volume in critical care patients.

Methods: This single-center retrospective cohort study included adult intensive care unit patients who developed new-onset diarrhea (Bristol Stool Form Scale ≥6 on 2 consecutive days) during EN. Based on Day 1 EN management, patients were classified as continuation (infusion rate decrease <10 mL/h) or reduction/discontinuation (decrease ≥10 mL/h or complete discontinuation). The primary outcome was cumulative diarrhea volume (grams) on Days 1-2. Cumulative EN calories (kcal) on Days 1-2 was a key secondary outcome. Inverse probability of treatment weighting with regression adjustment accounted for 8 pre-specified confounders. Sensitivity analyses included alternative exposure thresholds and propensity score models.

Results: Of 135 patients analyzed (median age, 74 years; 32% female), 96 (71.1%) continued EN and 39 (28.9%) underwent EN reduction/discontinuation. After adjustment, the reduction/discontinuation group had lower cumulative diarrhea volume on Days 1-2 (adjusted mean difference, -183.4 g; 95% confidence interval [CI], -350.1 to -16.7; p = 0.033) but received substantially fewer calories (-1260.1 kcal; 95% CI, -1464.4 to -1055.9; p < 0.001). The direction of the reduction in diarrhea volume was consistent across sensitivity analyses.

Conclusion: Reducing or discontinuing EN after diarrhea was associated with a modest reduction in diarrhea volume but a substantial caloric deficit. This trade-off should be considered when reducing EN for diarrhea.