Early Enteral Nutrition and Outcomes of Critically Ill Patients Treated With Vasopressors and Mechanical Ventilation

Abstract

Objective To determine the effect of early enteral feeding on the outcome of critically ill medical patients whose hemodynamic condition is unstable. Methods Prospectively collected data in a multi-institutional medical intensive care unit database were analyzed retrospectively. A total of 1174 patients were identified who required mechanical ventilation for more than 2 days and were treated with vasopressor agents to support blood pressure. The patients were divided into 2 groups: those who received enteral nutrition (n = 707) within 48 hours of the start of mechanical ventilation, termed the early enteral nutrition group, and those who did not (n = 467), termed the late enteral nutrition group. The primary end points were overall intensive care unit and hospital mortality. Subgroup analyses were used to evaluate potential confounding variables. The data were also analyzed after adjustments for confounding by matching for propensity score. Results Intensive care unit and hospital mortality were lower in the early enteral nutrition group than in the late enteral group: 22.5% vs 28.3%; P = 03; and 34.0% vs 44.0%; P < .001, respectively. The beneficial effect of early feeding was more evident in the sickest patients, that is, those treated with multiple vasopressors (odds ratio, 0.36; 95% confidence interval, 0.15-0.85) and those without early improvement (odds ratio, 0.59; 95% confidence interval, 0.39-0.90). When adjustments were made for confounding by matching for propensity score, early feeding was associated with decreased hospital mortality. Conclusion Early enteral nutrition may be associated with reduced intensive care unit and hospital mortality in patients whose hemodynamic condition is unstable.

Elimination of Radiographic Confirmation for Small-Bowel Feeding Tubes in Critical Care

“…1 Earlier versus later enteral nutrition also is associated with reductions in mortality rates in intensive care units (ICUs) and hospitals. 2 This evidence indicates that the later nutritional feedings are initiated, the greater the chance of complications, supporting timely initiation of enteral nutrition after hospital admission. Best-practice guidelines call for initiation of enteral feeding within 24 to 48 hours of admission for critical care patients.…”

Inadequação calórico-proteica e associação com Indicadores de Qualidade em Terapia Nutricional na assistência ao paciente crítico

“…7,16,20 Um estudo multicêntrico, com características similares a este estudo, realizado em 201 instituições de 26 países, avaliou a adequação calórico-proteica e constatou média de adequação de 61,2%, resultado semelhante ao deste estudo, que encontrou 62,7% de adequação calórica. 7 Entretanto, outro estudo multicêntrico encontrou adequação calórica de 45%, possivelmente em razão de estratégias pouco sistematizadas para nortear o manejo da TNE.…”

Enteral Nutrition After Advadvanced Combined Operative Interventions in Oncosurgery

“…Гемодинамическая нестабильность сама по себе не является абсолютным противопоказанием для проведе-ния энтерального питания, если есть доказательства адек-ватной перфузии тканей (нормальный уровень лактата крови) [47].…”