1. Gastrointestinal Symptoms and other Factors associated with Failure of Enteral Nutrition in Surgical Intensive Care Unit Session: Poster Poster No.: PP05 Style: Poster presentation PENSA 2015 Nagoya WeiChin Chiou 1.2.3. YiChun Chen 1. YuJen Yang 2. Critical Care, Surgical Department, Changhua Christian Hospital, Changhua, Taiwan 1. Nutrition Therapy Center, Changhua Christian Hospital, Changhua, Taiwan 2. Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan 3. Rationale Early enteral feeding is important in critical care. The mechanisms are keep immune function (GALT: gut associated lymphoid tissue) 、 anti-imflammatory endocrine status (TH2 pathway) and prevent gut translocation (keep mucosa function). In surgical intensive care unit, because of digestive tract surgery or unstable hemodynamic status, early or stable enteral feeding is difficult to routinely performed. It is helpful to increase early enteral feeding rate by set up a protocol. Before set up protocol, we research gastrointestinal (GI) symptoms and other factors that associated with failure of enteral nutrition. Methods We enrolled patients in surgical intensive care unit (SICU) 1, Changhua Christian hospital, medical center in Taiwan, since March 2013 to March 2015. This is an adult ICU with 28 beds which mainly for GI surgery patients. There are also other surgical critical and trauma patients except cardiovascular surgery patients. Patients with tube feeding were included and oral intake 、 non per os or younger than 18 years old were excluded. We recorded the GI symptoms while tube feeding including gastric residual volume 、 distension 、 diarrhea 、 vomit 、 GI bleeding and abdominal pain. Factors that insult enteral feeding were recorded. This survey was performed 4 to 5 days a week and case numbers recorded under person/day. Results 5807 patients in 227days (25.58 patients/day) were enrolled and 3918 patients included. The incidence rate of GI symptoms while tube feeding were gastric residual volume (5.26%) 、 dissension (2.81%) 、 diarrhea (2.19%) 、 vomit (1.38%) 、 gastrointestinal bleeding (0.28%) and abdominal pain (0.13%). Conclusions For better outcomes in surgical intensive unit, early and stable enteral nutrition is important. The most common symptom that decrease enteral feeding calories is GRV. Should we decrease feeding calories or even stop feeding according to GRV? The clinical role of GRV was debated. To setup a feeding protocol about tube feeding symptoms (especially GRV) and consider that stop feeding is necessary or unnecessary for variety procedures in SICU are helpful to achieve early and stable enteral nutrition in SICU. Mortality EN v.s No EN R.R: 0.62 95% C.I: 0.37-1.05 Early v.s Delayed EN R.R: 0.83 95% C.I: 0.49-1.39 Total R.R: 0.72 95% C.I: 0.50-1.04 Infectious complications EN v.s No ENR.R: 0.70 95% C.I: 0.48-1.02 Early v.s Delayed ENR.R: 0.86 95% C.I: 0.69-1.08 Total R.R: 0.81 95% C.I: 0.68-0.97 ICU length of stay Early v.s Delayed EN -0.78WND 95% C.I: -3.56 - 2.00 Hospital length of stay Early v.s Delayed EN -0.18WND 95% C.I: -8.15 - 7.80 Canadian Clinical Critical Practice Guideline 2013 Recommendation: Based on one level 1 and 13 level 2 studies When considering nutrition support for critically ill patients We strongly recommend the use of enteral nutrition over parenteral nutrition. Tube feeding ratio Enteral nutrition calories decreased in 6.38% of tube feeding patients per day. Factors that insults enteral feeding were gastric residual （ 2.25 ％ ) 、 procedures （ 2.40 ％ ) 、 vomit （ 1.02 ％ ) 、 diarrhea (0.15%) 、 distension (0.66%) 、 vomiting (1.02%) 、 abdominal pain (0.10%) 、 tube problems (0.08%) 、 bleeding (0.20%) and others (0.26%). Summary of recommendations for enteral nutrition in critically ill patients Level of evidence Enteral nutrition is associated with an improvement of nutritional variables, a lower incidence of infections and a reduced length of hospital stay.A Enteral nutrition should be started within the first 24 - 48 hours of admissionA Enteral nutrition is preferable to parenteral nutrition.B In ICU patients, neither the presence nor absence of bowel sounds and evidence of passage of flatus and stool is required for initiation of enteral nutrition. B Critically ill patients who cannot be fed orally for a period of more than three days must receive specialized nutritional support.C Enteral nutrition should provide 25 to 30 kcal/kg/day.C The feedings should be advanced toward goal over the next 48 - 72 hours.C The enteral nutrition must be deferred until the patient is hemodynamically stable.C Enteral Nutrition in Critical Care. J Clin Med Res 2013;5(1):1-11 Should we care about GRV ? JAMA. 2013;(3):249-256. Rice TW. Gastric residual volume: end of an era. JAMA 2013 Jan 16;309: 283-4