Exploring the safety of prolonging the hang time of enteral feeding systems in the intensive care unit.

BACKGROUND & AIMS: Prolonging the hang time (HT) of administration sets and enteral feeding containers beyond the recommended 24 h may reduce waste, decrease nursing workload and lower hospital costs. The objective of this pilot study was to explore the safety of extending the HT from 24 to 48 h by investigating its impact on the occurrence of diarrhoea and new-onset pneumonia in intensive care unit (ICU) patients.

METHODS

This monocenter pilot study had a combined retrospective and prospective cohort (24 and 48-h HT, respectively) design and included ICU patients (≥ 18 years) receiving enteral nutrition for at least 48 h. The primary outcome was diarrhoea, defined as (1) ≥ 3 defecations/day with a Bristol Stool Chart score of 6 or 7, or (2) colostomy/ileostomy output ≥1.5 L/24 h. The secondary outcome was new-onset pneumonia ≥48 h after ICU admission. Associations between HT protocol and the onset of outcomes were assessed by Cox regression analyses. Additionally, retrograde bacterial growth was assessed through microbiological analysis in enteral feeding systems.

RESULTS

A total of 102 ICU patients were included between December 16, 2023 and October 11, 2024, with 51 in each cohort. Actual median HT was 31 [27-45] hours vs. 56 [37-83] hours in the 24 and 48-h groups, respectively (p < 0.001). In multivariable Cox regression, no significant association was found between prolonged HT and diarrhoea-free survival (HR 0.92, 95 % CI 0.55-1.53, p = 0.746) and new-onset pneumonia (HR 1.33, 95 % CI 0.54-3.24, p = 0.537), respectively. Retrograde bacterial growth did not extend beyond the first 30 cm of the administration set and was not correlated to HT.

CONCLUSION

We observed no association between prolonging the HT of enteral feeding sets from 24 to 48 h and the occurrence of diarrhoea or new-onset pneumonia in ICU patients. However, a substantial, adequately powered, non-inferiority trial must be conducted prior to integrating extended hang times into clinical practice.