OBJECTIVES: Current guidance recommends initiation of early enteral nutrition (early EN) within 24–36 hours of ICU admission in critically ill COVID-19 patients. Despite this recommendation, there is quite limited evidence describing the effect of early EN on outcomes in COVID-19 patients. The association between early EN (within 3 d post intubation) and clinical outcomes in adult COVID-19 patients requiring mechanical ventilation (within 2 d post ICU admission) was evaluated. DESIGN: We performed a nationwide observational cohort study using a nationwide administrative-financial database (Premier) in United States. SETTING: Information pertaining to all COVID-19 patients admitted to ICU from 75 hospitals between April and December 2020 was analyzed. PATIENTS: A total of 861 COVID-19 patients were included. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Clinical outcomes were assessed via regression models to control for patient and hospital characteristics. We identified 513 COVID-19 ICU patients (59.2%) requiring mechanical ventilation who received early EN and had similar baseline characteristics to late EN group. Compared with late EN group, the early EN group had shorter ICU (hazard ratio [HR], 1.39; 95% CI, 1.15–1.68) and hospital length of stays (LOS) (HR, 1.53; 95% CI, 1.23–1.91), fewer mechanical ventilation days (HR, 1.25; 95% CI, 1.01–1.54), and lower cost (–$22,443; 95% CI, –$32,342 to –$12,534). All comparisons were statistically significant (p < 0.05). CONCLUSIONS: In patients with COVID-19 requiring mechanical ventilation, early EN is associated with earlier liberation from mechanical ventilation, shorter ICU and hospital LOS, and decreased cost. Our results are among the first to support guideline recommendations for initiation of early EN in COVID-19 ICU patients. Further, our data show nearly 40% of critically ill COVID-19 patients fail to have early EN initiated, even at 3 d post initiation of mechanical ventilation. These results emphasize the need for targeted strategies promoting initiation of early EN, as this may lead to improved clinical and economic outcomes in severe COVID-19 patients.

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One of the major concerns of the auditing profession is its increasing exposure to litigation, particularly with parties not historically considered to have privity under contract law. A major reason for the increase in lawsuits against accounting firms is that they are often the only survivors in a multiparty action when a company fails. In an attempt to reduce the disparity between the perceptions of the profession and the public as to the responsibilities of an independent auditor, the AICPA issued SAS58, one of the Expectation Gap auditing standards. SAS58 changed the wording of the standard unqualified auditors report, but did not alter the underlying audit process or the auditors responsibility for the audited financial statements. Previous research suggests that jurors assessments of liability in audit failure suits have not been affected by SAS58. However, this research was based on a join and several liability model, and did not address the possibility that SAS58, in conjunction with tort reform legislation, may modify jurors perceptions of auditor liability. The present study was designed to explore that interaction.

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