The value of bowel sound assessment in predicting feeding intolerance in critically ill patients

Background: Early nutritional support in critical illness is important. There exists a debate about whether and when to initiate enteral nutrition as opposed to feeding parenterally. In addition to other indicators, nonspecific indicators such as bowel sound are used in the decision, but there is little evidence to show the value of bowel sound. Methods: Feeding intolerance was assessed and correlated with the presence or absence of bowel sound as documented by the bedside nurse in 203 critically ill patients who were fed enterally for >48 hours at King Fahad National Guard Hospital in King Abdulaziz Medical City, Riyadh, Saudi Arabia. Results: The absence of bowel sound in critically ill patients was associated with low caloric intake and with feeding intolerance. However, a large proportion of patients with absent bowel sound delayed feeding especially if this assessment was performed prior to initiating enteral feeding. Conclusions: This study demonstrates weak correlation between bowel sound and caloric intake and feeding intolerance. Therefore, a decision regarding the initiation of enteral nutrition may not be based solely on the assessment of bowel sound and other nonspecific indicators. From College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia (Abdullah AlShimemeri, Samir Haddad, Yaseen Arabi), and King Fahad National Guard Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia (Maram Sakkijha) Address for correspondence: Abdullah AlShimemeri, MD, MBChB, FCCP, EDIC, FRCP(C) Executive Director, Health Promotion Center Associate Professor, College of Medicine King Saud Bin Abdulaziz University for Health Sciences Consultant, Pulmonary & Critical Care Medicine King Fahad National Guard Hospital, King Abdulaziz Medical City PO Box 22490, Riyadh 11426, Saudi Arabia Tel: +966-1-2520088x12342/x18855/x18877