Assessment of risk factors leading to intolerance to enteral nutritional therapy in adult critically ill patients: a literature review
DOI:
https://doi.org/10.55892/jrg.v9i20.2864Keywords:
acute gastrointestinal injury, risk factors, gastrointestinal dysfunction, intensive care unit, enteral nutritionAbstract
In hemodynamic instability, the gastrointestinal tract is one of the first organs affected, compromising its integrity, leading to increased intestinal permeability, cell apoptosis, bacterial translocation, and consequently to inflammation and dysfunction. gastrointestinal dysfunction (GID), defined as acute gastrointestinal injury (AGI), manifests as motility and absorption disorders and is directly associated with enteral nutritional intolerance (ENI), longer hospital stays, increased risk of infection, and increased mortality. This integrative literature review aimed to analyze the risk factors associated with ENI and their clinical applicability. Eighteen studies published between 2015 and 2025, involving critically ill adult patients, were included. These findings highlight that AGI grades III-IV were associated with higher mortality between 28 and 60 days, with the SOFA score being an independent predictor. Mortality was related to food intolerance in the first week of hospitalization. Unfavorable outcomes correlated with lower caloric intake of enteral nutrition and a higher prevalence of elevated gastric residual volume in patients with more severe AGI. There was an association between reduced plasma levels of citrulline and glutamine and a higher prevalence of AGI, while pH, IL-10, and sIgA were independent predictors of gastrointestinal failure. Elevated BPH levels were associated with the development of NSI. Transabdominal ultrasound indicators demonstrated predictive capacity for NSI, in addition to independently predicting 28-day mortality. The Gastrointestinal Dysfunction Score was developed to provide an objective assessment of DFGI and maintain predictive capacity for mortality at 28 and 90 days. The findings indicate that DFGI and INE, complex and multifactorial conditions, are highly prevalent and associated with unfavorable outcomes. Thus, the need for further studies to better understand the risk factors and define protocols for enteral nutritional therapy to improve survival and clinical outcomes in these patients is highlighted.
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