الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Critical care nutrition plays a pivotal role in managing critically ill patients, where optimal nutritional support is essential for maintaining metabolic function, preserving lean body mass, and supporting immune function. In the intensive care setting, patients often experience metabolic stress, catabolism, and heightened nutritional requirements due to underlying illness, injury, or surgical interventions. Consequently, early initiation of enteral nutrition has emerged as a cornerstone of critical care management, aiming to mitigate the harmful effects of malnutrition, minimize complications, and expedite recovery.
This study aimed to establish the benefits of early initiation of enteral tube feeding in critically ill patients. The primary goal was to assess the tolerability of early gastric tube feeding using ultrasound and clinical evaluations. Secondary objectives included investigating the impact of early enteral tube feeding on nutritional status, clinical outcomes, adverse effects, and the efficacy of gastric ultrasound in guiding feeding by tracing gastric residual volume (GRV).
The study in the Alexandria Main University Hospital intensive care units enrolled 50 adult patients indicated for enteral gastric tube feeding. Reasons for ICU admission were diverse, including neurological conditions, maxillofacial surgery, respiratory illnesses, and trauma. Comorbidities were prevalent, with cerebrovascular disease, diabetes, cardiovascular disease, cancer, respiratory disease, and chronic kidney disease being common.
Demographic analysis revealed a balanced distribution between genders, with 27 males and 23 females enrolled in the study. The age range of the cohort spanned from 20 to 83 years, with a mean age of 54.18 years, highlighting the heterogeneity of the patient population.
Baseline characteristics indicated a wide spectrum of reasons for ICU admission, including neurological conditions (52%), maxillofacial surgery (16%), respiratory illnesses (20%), and trauma (12%). Comorbidities were prevalent among the study cohort, with cerebrovascular disease (52%), diabetes (32%), cardiovascular disease (42%), cancer (20%), respiratory disease (24%), and chronic kidney disease (4%). Gastric tube feeding was initiated early in the morning, and symptoms of feeding intolerance were assessed multiple times daily (every 6 hours) over five days. Clinical symptoms, such as nausea, vomiting, diarrhea, and abdominal distention, were observed in a relatively low percentage of cases.
Gastric residual volume measurements revealed a high success rate in achieving target feeding volumes. Analysis of clinical symptoms revealed relatively low incidences of feeding intolerance, with nausea occurring in 14% of cases, vomiting in 14%, constipation in 18%, abdominal distention in 12%, and diarrhea in 12%. These findings underscored the overall tolerability of early enteral feeding initiation in the study cohort, despite underlying critical illness and comorbidities.
Gastric ultrasound emerged as a valuable tool for assessing gastric residual volume, a critical parameter in monitoring enteral feeding tolerance. Using gastric ultrasound allowed for real-time visualization and quantification of gastric contents, enabling accurate and non-invasive residual volume measurement. Regular monitoring of gastric residual volume using ultrasound facilitated early detection of feeding intolerance and informed clinical decision-making regarding the adjustment of feeding regimens. By integrating advanced imaging techniques into routine clinical practice, the study demonstrated the feasibility and reliability of ultrasound-guided monitoring in optimizing enteral feeding management in critically ill patients.