Comparison of Feeding Efficiency and Hospital Mortality between Small Bowel and Nasogastric Tube Feeding in Critically Ill Patients at High Nutritional Risk

Abstract

<jats:p>Nasogastric tube enteral nutrition (NGEN) should be initiated within 48 h for patients at high nutritional risk. However, whether small bowel enteral nutrition (SBEN) should be routinely used instead of NGEN to improve hospital mortality remains unclear. We retrospectively analyzed 113 critically ill patients with modified Nutrition Risk in Critically Ill (mNUTRIC) score ≥ 5 and feeding volume &lt; 750 mL/day in the first week of their stay in the intensive care unit (ICU). Age, sex, mNUTRIC score, and Acute Physiology and Chronic Health Evaluation II (APACHE II) score were matched in the SBEN (n = 48) and NGEN (n = 65) groups. Through a univariate analysis, factors associated with hospital mortality were SBEN group (hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.31–1.00), Simplified Organ Failure Assessment (SOFA) score on day 7 (HR, 1.12; 95% CI, 1.03–1.22), and energy intake achievement rate &lt; 65% (HR, 2.53; 95% CI, 1.25–5.11). A multivariate analysis indicated that energy intake achievement rate &lt; 65% on the third follow-up day (HR, 2.29; 95% CI, 1.12–4.69) was the only factor independently associated with mortality. We suggest initiation of SBEN on the seventh ICU day before parenteral nutrition initiation for critically ill patients at high nutrition risk.</jats:p>

Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy

“…Therefore, our study was the first to demonstrate that mNUTRIC score, rather than APACHE II or SOFA score, is significantly associated with ICU mortality for adult patients with ARDS requiring PP therapy. As our previous study also demonstrated [ 8 , 9 , 10 , 11 ], mNUTRIC score is a useful tool to evaluate nutritional risk in critically ill adult patients admitted to medical ICUs.…”

“…However, Reignier et al revealed a significant improvement in feeding volume after a feeding protocol implementation in ARDS patients required PP therapy [ 41 ]. Because our RICU has evaluated nutritional risk and implemented the feeding protocol within 24 h of admission for all critically ill patients since 2016 [ 8 , 9 , 10 , 11 ], feeding targets are monitored and titrated to the maximum volume, even for patients requiring PP therapy. Therefore, our study also revealed that the difference in EAR on each day ( Figure 2 ), rather than the average EAR in the first week of ICU admission, provides more information regarding mortality risk for patients receiving the feeding protocol.…”

“…The primary outcome was the correlation between energy intake achievement rate and ICU mortality. We identified an EAR of <65% in the first week of ICU admission as a poor prognostic factor for patients with high nutritional risk in our previous study [ 8 , 11 ], and this study was conducted to confirm the power of this predictor of ICU mortality.…”

“…The evaluation of nutritional risk and suggestions for personalized nutritional prescriptions have been supported by a registered dietitian in our RICU since 2016. The mNUTRIC score and EAR were recorded, and nutritional prescriptions were suggested by the dietitian, as in our previous studies [ 8 , 9 , 10 , 11 , 29 ]. Early EN, the standard of care, was provided through a nasogastric tube on the first day of RICU admission for each patient, even for those requiring PP therapy [ 25 ].…”

“…Daily EAR (%) was recorded on the index day and the seven days thereafter. The energy intake and energy intake achievement rate (%) of each day were calculated as follows: (actual energy intake/estimated energy requirement) × 100 [ 8 , 9 , 10 , 11 ]. The primary outcome was the correlation between energy intake achievement rate and ICU mortality.…”