Effect of Early Enteral Nutrition on Clinical Outcomes in ICU Patients.
DOI:
https://doi.org/10.51168/42y08f20Keywords:
Early enteral nutrition, critically ill patients, intensive care unit, nutritional support, ICU mortality, mechanical ventilation, infectious complicationsAbstract
BackgroundCritically ill patients are at high risk of nutritional inadequacy because of increased metabolic demands, reduced oral intake, and interruptions in feeding. Early enteral nutrition (EEN) is generally recommended when the gastrointestinal tract is functional and feeding is clinically feasible.
Objective
To assess the association between early enteral nutrition and clinical outcomes among critically ill patients admitted to the intensive care unit (ICU).
Methods
A prospective observational study was conducted among 200 adult ICU patients at RIMS, Ranchi, from January to August 2024. Patients were categorized according to initiation of enteral nutrition as an early enteral nutrition group (≤48 hours; n=120) or a delayed enteral nutrition group (>48 hours; n=80). Clinical outcomes including ICU length of stay, duration of mechanical ventilation, infectious complications, feeding intolerance, and ICU mortality were compared between the groups. Categorical variables were analysed using the chi-square test and continuous variables using the independent-samples t-test. A p-value <0.05 was considered statistically significant.
Results
ICU mortality was lower among patients receiving early enteral nutrition than among those receiving delayed nutrition (15.0% vs 27.5%; χ²=5.02, p=0.025). Mean ICU stay was shorter in the early group (8.6±3.4 vs 10.4±4.1 days; p=0.001), as was mean duration of mechanical ventilation (5.7±2.8 vs 7.1±3.2 days; p=0.001). Infectious complications occurred in 20.8% of the early group compared with 35.0% of the delayed group (χ²=5.32, p=0.021). Feeding intolerance was observed more frequently in the early group (18.3% vs 11.3%; p=0.176).
Conclusion
In this cohort, initiation of enteral nutrition within 48 hours was associated with lower ICU mortality, shorter ICU stay, shorter mechanical ventilation, and fewer infectious complications. Prospective controlled studies are needed to establish causality.
References
1. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr. 2016;40(2):159-211. https://doi.org/10.1177/0148607115621863
2. Taylor BE, McClave SA, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient. Crit Care Med. 2016;44(2):390-438. https://doi.org/10.1097/CCM.0000000000001525
3. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48-79. https://doi.org/10.1016/j.clnu.2018.08.037
4. Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, et al. Trial of the route of early nutritional support in critically ill adults. N Engl J Med. 2014;371(18):1673-84. https://doi.org/10.1056/NEJMoa1409860
5. Reignier J, Boisramé-Helms J, Brisard L, Lascarrou JB, Hantala F, Anguel N, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018;391(10116):133-43. https://doi.org/10.1016/S0140-6736(17)32146-3
6. Elke G, Wang M, Weiler N, Day AG, Heyland DK. Close to recommended caloric and protein intake by enteral or parenteral nutrition is associated with better clinical outcomes in critically ill patients: secondary analysis of a multinational, observational study. Crit Care. 2014;18(5):R140. https://doi.org/10.1186/cc13720
7. Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med. 2009;35(12):2018-27. https://doi.org/10.1007/s00134-009-1664-4
8. Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011;365(6):506-17. https://doi.org/10.1056/NEJMoa1102662
9. Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, et al. A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES). Health Technol Assess. 2016;20(28):1-144. https://doi.org/10.3310/hta20280
10. Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, et al. Permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med. 2015;372(25):2398-408. https://doi.org/10.1056/NEJMoa1502826
11. Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012;307(8):795-803. doi:10.1001/jama.2012.137. https://doi.org/10.1001/jama.2012.137
12. Petros S, Engelmann L. Enteral nutrition delivery and energy expenditure in critically ill patients. Clin Nutr. 2006;25(1):51-8. https://doi.org/10.1016/j.clnu.2005.08.013
13. Elke G, van Zanten ARH, Lemieux M, McCall M, Jeejeebhoy KN, Kott M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20:117. https://doi.org/10.1186/s13054-016-1298-1
14. Elke G, Hartl WH, Kreymann KG, Avenell A, Ebner C, Frühwald S, et al. Clinical nutrition in intensive care medicine. Crit Care. 2019;23:35.
15. Marik PE, Zaloga GP. Early enteral nutrition in acutely ill patients: a systematic review. Crit Care Med. 2001;29(12):2264-70. https://doi.org/10.1097/00003246-200112000-00005
16. Doig GS, Simpson F, Heighes PT, Bellomo R, Chesher D, Caterson ID, et al. Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, single-blind controlled trial. Lancet Respir Med. 2015;3(12):943-52. https://doi.org/10.1016/S2213-2600(15)00418-X
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Copyright (c) 2024 Dr. Sudipto Banerjee, Dr. Barun Ram, Dr. Rakesh Raushan, Dr. Pradip Kumar
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