(418) Low Rates of Feeding Intolerance With Neuromuscular Blockade in Acute Respiratory Distress Syndrome

Introduction: Enteral nutrition (EN) is widely accepted as the preferred route of feeding when critically ill patients experience inadequate oral intake and should be initiated early during intensive care unit (ICU) stay. The safety of EN in patients undergoing sustained neuromuscular blockade (sNMB) is controversial due to concerns that neuromuscular blockade may contribute to gastric dysfunction. The incidence of and risk factors for enteral feeding intolerance (EFI) in patients with acute respiratory distress syndrome (ARDS), receiving sNMB is currently unknown.

Methods: This single center, retrospective cohort study included adult patients admitted to the surgical or medical ICU, who had a diagnosis of ARDS and received EN during sNMB for a minimum of 12 hours. EFI was defined as patients experiencing one or more of the following: gastric residual volume greater than 500 mL, emesis episode while receiving EN, new or worsening bowel distension or new or worsening bowel ischemia confirmed by imaging. Statistical analysis was performed by Fisher’s exact test and Wilcoxon rank sum for nonparametric continuous data.

Results: 147 patients were included in the analysis. Of these, 21 (14.3%) experienced EFI. The majority of EFI incidences were due to gastric residual volumes >500 mL (71.4%), followed by emesis (19.0%) and new or worsening bowel distension (9.5%). No patients experienced bowel ischemia. Overall, 88.4% of patients received enteral nutrition within 48 hours of ICU admission. Inpatient mortality (85 (67.5) vs 13 (61.9), p=0.624), ICU length of stay (15.45 [11.1-23.0] days vs 12.8 [9.1-24.1] days, p=0.973) and hospital length of stay (19.35 [13.1-31.5] days vs 16.9 [10.1-30.1] day, p=0.662) were not statistically different between those that did not and those that did develop EFI, respectively.

Conclusions: The rate of EFI in patients with receiving enteral nutrition with sNMB was low, suggesting enteral nutrition should not be withheld purely due to use of sNMB in ARDS patients. Ongoing research may be needed to assess risk factors for EFI in critically ill patients undergoing sNMB for ARDS.