327: The Effect of Enteral Nutrition Strategy on Diarrhea: Preliminary Results From the Ennd Goals Study

Introduction: Early enteral nutrition (EN) has become standard of care for most ICU patients. Despite this, the effect of different EN modalities, including intermittent (IEN) vs. continuous EN (CEN), is under-investigated. We evaluated the effect of IEN vs CEN on diarrhea and other GI symptoms amongst critically ill patients. Methods: The ENND Goals study is a multicentre retrospective cohort study in Hamilton, Canada. Patients greater than 18 years of age, admitted to the ICU and receiving EN for at least 48 hours were included. Differences between groups were determined by chi-square analysis and two-tailed Welch’s T-test. Predictors of EN strategy and diarrhea were determined via multivariable logistic regression. Results: Overall, 236 patients (84 female 35.6 %, mean age 61.7 years SD 16.6) were admitted to Hamilton Health Sciences between Jan 1, 2023, and Dec 31, 2023. Of them, 41 (17%) received IEN (14 (5.9%) for most of their ICU admission and 27 (11%) for some of their admission), and 195 (83%) received only CEN. Trauma patients, younger patients and patients with lower BMI were significantly more likely to receive IEN during their admission (OR 4.42 95%CI 1.27-15.3; 0.97 95%CI 0.95-0.99 and 0.92 95%CI 0.87-0.98 respectively). Those who received IEN had a similar incidence of days with diarrhea (0.04 per person-day 95%CI 0.02-0.05) compared to those who only received CEN (0.04 per person-day 95%CI 0.03-0.05, p=0.745). There was no significant difference in terms of ICU-acquired infections or emesis. In multivariable analysis, receipt of IEN for at least some of the ICU stay was associated with an increased risk of developing diarrhea (OR 3.76; 95% CI, 1.56–9.05; p = 0.003). Conclusions: In one year of ICU admissions at Hamilton Health Sciences, only 17% of patients requiring EN for 48 hours received IEN. While patients who received at least some IEN were more likely to develop diarrhea in the ICU, there was no difference in the incidence of diarrhea, emesis, or hospital-acquired infections, when compared to those who received only CEN. Further study is needed to determine the optimal EN strategy amongst critically ill patients.