• Nam Nguyen, Katrina Ching, Robert Fraser, Marianne Chapman, and Richard Holloway.
• Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, North Terrace, Adelaide, 5000, Australia. quoc.nguyen@health.sa.gov.au
• Intensive Care Med. 2007 Dec 1; 33 (12): 2085-92.

ObjectiveTo assess the relationship between blood glucose concentrations (BSL) and intolerance to gastric feeding in critically ill patients.DesignProspective, case-controlled study.Patients And ParticipantsTwo-hourly BSL and insulin requirements over the first 10 days after admission were assessed in 95 consecutive feed-intolerant (NG aspirate > 250 ml during feed) critically ill patients and 50 age-matched, feed-tolerant patients who received feeds for at least 3 days. Patients with diabetes mellitus were excluded. A standard insulin protocol was used to maintain BSL at 5.0-7.9 mmol.Measurements And ResultsThe peak BSLs were significantly higher before and during enteral feeding in feed-intolerant patients. The mean and trough BSLs were, however, similar between the two groups on admission, 24 h prior to feeding and for the first 4 days of feeding. The variations in BSLs over 24 h before and during enteral feeding were significantly greater in feed-intolerant patients. A BSL greater than 10 mmol/l was more prevalent in patients with feed intolerance during enteral feeding. The time taken to develop feed intolerance was inversely related to the admission BSL (r= -0.40). The amount of insulin administered before and during enteral feeding was similar between the two groups.ConclusionsFeed intolerance in critically ill patients is associated with a greater degree of glycaemic variation, with a greater number of patients with transient hyperglycaemia. These data suggest more intensive insulin therapy may be required to minimize feed intolerance, an issue that warrants further study.

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