| Feeding intolerance(FI)is a key factor that restricts critically ill patients to reaching the nutrient intake target during enteral feeding,which would cause poor prognosis and clinical outcomes.Therefore,it is greatly significant to evaluate the risk of feeding intolerance and take effective measures to reduce the incidence of complications.However,there is no risk assessment scale of enteral feeding intolerance for clinic yet.Our group has preliminarily developed the risk assessment scale of enteral feeding intolerance,and this study was focused on the verification of the scale,including assessing its reliability and validity,and analyzing the factors that influence the enteral feeding intolerance.Part 1 The reliability and validity of the risk assessment scale of enteral feeding intolerance for critically ill patients1.ObjectiveVerify the accuracy and clinical applicability of the risk assessment scale of enteral feeding intolerance for critically ill patients.2.Methods(1)Reliability.We evaluated the scorer reliability of the scale.Patients were assessed by two investigators using the scale to calculate the scorer reliability of the scale.(2)Validity.We evaluated the empirical validity,content validity,and construct validity of the scale.The empirical validity of the scale was evaluated by correlation analysis based on the clinical data;6 experts from 6 grade-A hospitals in 5 cities were invited to assess the content validity of the scale;the construct validity was evaluated by analyzing the risk assessment results of FI using factor analysis.(3)Clinical applicability.We selected a sample of 110 medical staff in ICU from 3 grade-A hospitals in Chongqing by purposive sampling to evaluate the completion rate,assessment time,and satisfaction of the scale.3.1 Reliability of the risk assessment scale of enteral feeding intolerance for critically ill patientsScorer reliability.The total score of the Spearman correlation coefficien t of two investigators was 0.98,P=0.000;the Spearman correlation coefficient of each dimenision score was between 0.79 and 1.00,P<0.01,which was statistically significant,indicating the assessment results of the two investigators has high consistency.3.2 Validity of the risk assessment scale of enteral feeding intolerance for critically ill patients(1)Empirical validity.The Pearson ?2 test showed that the score of the scale items has high correlation with the occurrence of FI(P<0.05,Kappa=0.79),demonstrating that the scale has high accuracy.Under different levels of the scores,the actual incidence rate of FI was 11.11% patients with scores<17,88.10% with grade?(17?scores?21),89.66% with grade?(22?scores?32),and 100.00% with grade ?(scores?33).Furthermore,90.75% patients with scores ?17.The results indicated that score 17 was a sensitive testing threshold,and there was significant difference between < 17 and ?17(P=0.000).However,there was no significant difference between each two levels when scores ?17(Grade?~?)(P=0.305),so we revised the risk levels of the scale of low risk(< 17)and high risk(?17).(2)Content validity.The authority of the experts was 0.932>0.700,indicating that the degree of expert authority in the study was high,and the score was reliable;except for “Glucose?11mmol/L”(2.83±0.41),the scores of all items were ?3(3 means complete correlation),and except for “AGI ?”(I-CVI was 0.67),the scores of all items were ?0.83,and the S-CVI was 0.92>0.90,demonstrating the score of the scale items has high correlation with the occurrence of FI,and the scale has a good content validity;according to the suggestions of the experts,we changed the item “sedative and analgesic agents” by “sedative and analgesic agents(patients with unconscious)”,“systemic or intestinal infection” by “sepsis”,and indicated head injury under different GCS scores in the scale for better assessment.(3)Construct validity.The KMO=0.59 > 0.50,Bartlet test,?2=597.21,P<0.01,indicating that it was suitable for factor analysis.The principal component method was used to extract the common factor,in which a total of 7 common factors were more than 1,and 3.Results the cumulative contribution rate was 59.31%.The items “1 days after operation” and “anti-acid agent” with the maximum factor load factor of<0.4,and the maximum factor loading coefficient of all other items of are >0.4,which can be considered the scale has a good construct validity.3.3 The clinical applicability of risk assessment scale for enteral feeding intolerance(1)Completion rate.The completion rate of the scale was 96.63%.(2)Assessment time.The average assessment time of the scale was 7.87±4.49 minutes,the shortest assessment time was 3 minutes,and the longest was 30 minutes.(3)Scale satisfaction.The satisfaction degrees of scale structure,length and convenience were evaluated,and all the average scores>4(5 means very satisfactory).In the evaluation of satisfaction between the primary and senior nurses,the primary nurses had lower satisfaction compared with the senior,and there was significant different in the scale length(P<0.05).4.ConclusionThe risk assessment scale of enteral feeding intolerance for critically ill patients we preliminarily developed has high reliability,validity,and satisfaction.Part 2 Analysis of the influence factors of feeding intolerance1.ObjectiveAssess the risk of the FI using the scale and observe its actual occurrence to verify its accuracy and applicability further.Analyze the assessment results and common clinical measures that effecting the FI,to find out the correlation among assessment results of the scale,common clinical measures,and actual occurrence of FI.2.MethodsProspective observation analysis was applied to assess the risk of FI using the scale.From 1 to 5 days of enteral nutrition,the occurrence of FI and common clinical measures were recorded,including the type of nutrient solution,early use(when enteral nutrition starts)of catharsis,enema,prokinetic drugs,and supplemented albumin,use of probiotics,glutamine,combined with parenteral nutrition,to analyze the correlation among assessment results of the scale,common clinical measures,and actual occurrence of FI.3.Results(1)The correlation between assessment results of the scale and actual occurrence of FI.The correlation coefficient was 0.79(P=0.000),indicating there was positive correlation between assessment results of the scale and the actual occurrence of FI.Diagnostic test showed that the area under the ROC curve was 0.900,indicating the assessment results of the scale had high accuracy,YI=0.79,sensitivity was 92.31%,specificity was 86.75%,indicating the scale has high sensitivity,specificity,and comprehensive diagnosis ability.(2)Single factor analysis showed that feeding intolerance had greatly relat ionship with types of nutrient solution,early use of catharsis,enema,prokinetic drugs,supplemented album(P<0.05).(3)Multivariate logistic regression analysis showed that types of nutrient solution(OR=0.148,P=0.000,95% CI: 0.063~0.344),early use of enema(OR=0.184,P=0.000,95% CI: 0.082~0.416),early use of prokinetic drugs(OR=0.134,P=0.000,95% CI: 0.047~0.377)were the mean influence factors.And the further analysis showed that early use of enema(OR=0.193,P=0.028,95% CI: 0.044~0.837),early use of prokinetic drugs(OR=0.146,P=0.026,95% CI: 0.027~0.799)were the main independent protective factors to reduce incidence of FI with the high-risk patients.4.ConclusionThe risk assessment scale of enteral feeding intolerance for critically ill patients could predict the actual clinical FI occurrence well;early use of enema,prokinetic drugs,choosing whole protein type of nutrient solution are the protective factors to reduce the FI. |
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