ENTERAL FEEDING IN POST SURGICAL INTENSIVE CARE UNIT: FOLLOW CIRCADIAN RHYTMS

Introduction The environment and the treatments during hospitalization change circadian rhythms. The administration of continuous enteral nutrition disables the physiological alternation of hunger-thirst stimuli and their satisfaction. At nighttime, our body takes a series of modifications to facilitate rest. The purpose of the study was to improve the synchronism between nutrition administration and circadian response. Materials and methods The study was conducted in Post Surgical Intensive Care of Sant'Andrea Hospital in Rome. It included 72 patients, (53M/19F, mean age 68.6 years, BMI 19.4) hospitalized for complications related to major abdominal surgery. Diabetes patients were excluded. All patients were subjected to enteral nutrition (NE) with nutritional blend through nasogastric tube. The administration was carried out for a period of 18 hours, from 6 a.m. to 24, with a night-time suspension. For qualitative purposes, nocturnal awakening periods have been calculated and the use of sleeping drugs. After 48 hours, a questionnaire on perceived sleep quality was given to all patients. Results The nutritional target was reached within 72 hours by adjusting the rate of NE administration. Blood glucose has maintained average daytime values of 127.3mg/dl and nightly of 105.4mg/dl. Three hypoglycaemic episodes have been reported in morning relief before the recovery of NE in two patients without clinical symptoms. Five patients did not complete the study for new surgical intervention. Three patients needed anxiolytic drugs for psychomotor agitation not related to the night. All patients showed satisfaction for the administration regimen with a better perception of nighttime rest. Conclusions NE administration during daytime hours has proven effective from the nutritional point of view. Furthermore it showed good patient tolerability. There have been few cases of night-time awakening, mainly related to health interventions on the patient or near patients. Patients reported satisfaction and showed better reactivity in the morning.