Analysis of influencing factors and nursing strategies for enteral nutrition patients complicated with refeeding syndrome in ICU

Objective To analyze the influencing factors and nursing strategies for enteral nutrition patients complicated with refeeding syndrome (RS) in the ICU. Methods A total of 173 enteral nutrition patients in the ICU admitted to our hospital from January 2020 to January 2021 were retrospectively analyzed. Patients were divided into a control group (without RS, n = 128) and an observation group (with RS, n = 45) based on whether they developed RS. The general data such as gender, age, and body mass index (BMI) of patients were compared. The enteral nutrition-related indexes of two groups such as gastrointestinal decompression before feeding, diuretic application before feeding, and parenteral nutrition were compared. The risk factors of RS in ICU enteral nutrition patients were analyzed by multivariate logistic regression. Patients in the observation group received targeted nursing strategies according to the risk factors. The levels of serum phosphorus, potassium, magnesium, albumin, and prealbumin were detected before and after nursing intervention. Results The proportion of age >= 60 years, BMI >= 18.5 kg/m(2), diabetes history, cerebrovascular disease, severe pneumonia, acute physiology and chronic health evaluation (APACHE) II score > 20, duration of mechanical ventilation >= 3 days, NRS 2002 rating high risk in the observation group was much higher than that in the control group (P < 0.05). The observation group had a much higher proportion of whole protein nutrient solution, nasoenteric tube feeding, protein intake >= 1.2 g/kg, feeding speed > 50 ml/h, and enteral nutrition temperature 36-38 degrees C than the control group (P < 0.05). Multivariate logistic regression analysis pointed out that age >= 60 years, NRS 2002 score > 5, duration of mechanical ventilation >= 3 days, APACHE II score > 20, feeding speed > 50 ml/h, protein intake >= 1.2 g/kg, and enteral nutrition temperature 36-38 degrees C were independent risk factors of enteral nutrition patients complicated with RS in ICU (P < 0.05). After the intervention of targeted nursing strategies, the serum levels of phosphorus, potassium, magnesium, albumin, and prealbumin were obviously elevated than before (P < 0.05). Conclusion Age, NRS 2002 score, mechanical ventilation time, APACHE II score, feeding speed, protein intake, and enteral nutrition temperature are all risk factors of refeeding syndrome in ICU enteral nutrition patients. Targeted nursing intervention according to the influencing factors can effectively improve the efficacy of enteral nutrition and reduce or prevent other complications.