THE VALUE OF BOWEL SOUND

ASSESSMENT IN PREDICTING
FEEDING INTOLERANCE IN
CRITICALLY ILL PATIENTS
Ashley Prendergast, Sage Dietetic
Internship

Critically Ill

What is the definition of a critically ill

patient?

A disease or state in which death is

possible or imminent
High risk for actual or potential lifethreatening health problems
Vulnerable
Unstable
Complex
Require intense care

Causes

Injury

Traumatic
Surgical
Inflammatory

Infection
Acute Exacerbation of Chronic Illness

Nutrition Support

Positive patient outcomes

Reduction in disease severity

Complications
Morbidity
Mortality
LOS
Cost

How to Feed

Oral

Enteral

Parental

History of NS in Critical
Illness

1970s gut in latent stage in critical

illness

Late 1970s learned more about how

the body reacts to stress

PN as the standard

EN > TPN

Physiologic advantages

Better utilization
Glucose tolerance
metabolically active, immunologically
important, and bacteriologically decisive
organ in the critically ill
ASPEN recd

GI Function

Medical and Surgical hx

Coordination of Care
Patient input
Findings from physicals

BS as Indicator

Air-fluid interface moving through bowel

No air, no BS

Not an accurate or definite indicator of

peristalsis

Monitoring

Stool output

Gastric residuals

Abdominal distention

. Study Question:
Does the presence of BS have
an effect on feeding tolerance
and caloric intake?

Patients

203 ICU patients

King Fahad National Guard Hospital in
Saudi Arabia
Fed enterally >48 hours
Duration: 1 year
Exclusion:

DNR
Brain-dead
Re-admissions

Methods

Demographics recorded

Height
Weight
Caloric requirements

First 5 days

Caloric intake
Feeding intolerance (residuals >150 ml or 2
episodes vomiting)

Methods

BS Assessment

Bedside nurse
Absent/diminished/normal
Before and after initiation of EN

Results

Feeding intolerance

Occurred in 38% with documented ABS

before EN initiation
After EN, ABS highly associated with
feeding intolerance

Caloric Intake

Lower in pts with ABS

Discussion

Assumption:

BS correlate with peristalsis

Experts believe initiation of EN in absence
of BS can be appropriate

SCCM and ASPEN

In the ICU patient population, neither the

presence nor absence of bowel sound nor
evidence of passage of flatus and stool is
required for the initiation of enteral
feeding.

Conclusion

Weak correlation between absent BS and

feeding intolerances
Feeding stimulates BS
Absence of BS after initiating feeds is
more predictive of feeding intolerance
EN should not be held on absence of BS
alone

References

Heyland D, Cook DJ, Winder B, Brylowski L, Van

deMark H, Guyatt G. Enteral nutrition in the critically
ill patient: a prospective survey. Crit Care Med
1995;23:1055-60.
Academy of Nutrition and Dietetics. Nutrition Care
Manual. Critical Illness.
https://www.nutritioncaremanual.org/topic.cfm?
ncm_category_id=1&ncm_toc_id=37030&ncm_heading
=Nutrition%20Care&ncm_content_id=89662#
NutritionPrescription Accessed October 9, 2015.
Academy of Nutrition and Dietetics. Nutrition Care
Manual. Critical Illness. https
://www.nutritioncaremanual.org/topic.cfm?ncm_c
ategory_id=11&ncm_toc_id=255291&ncm_heading=Re
sources&ncm_content_id=109586#