Early vs Delayed Enteral Nutrition in Critically Ill Medical Patients

Woo, Susan Hamblin; Finch, Christopher K.; Broyles, Joyce E.; Wan, Jim Y.; Boswell, Richard L.; Hurdle, April C.

doi:10.1177/0884533610361605

Cited by 33 publications

(31 citation statements)

References 20 publications

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“…Often, hospitalized elderly patients who are nutritionally depleted develop pneumonia leading to respiratory failure [25, 26]. When patients have impaired underlying lung function and suffer from infections such as pneumonia, they fail to oxygenate the blood properly, leading to respiratory failure and the need for mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia

Tseng

Huang

Chen

et al. 2012

The Scientific World Journal

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Objectives. To determine risk factors associated with ventilator dependence in patients with ventilator-associated pneumonia (VAP). Study Design. A retrospective study was conducted at Chang Gung Memorial Hospital, Kaohsiung, from January 1, 2007 to January 31, 2008. Methods. This study evaluated 163 adult patients (aged ≥18 years). Eligibility was evaluated according to the criterion for VAP, Sequential Organ Failure Assessment (SOFA) score, Acute Physiological Assessment and Chronic Health Evaluation II (APACHE II) score. Oxygenation index, underlying comorbidities, septic shock status, previous tracheostomy status, and factors related to pneumonia were collected for analysis. Results. Of the 163 VAP patients in the study, 90 patients survived, yielding a mortality rate of 44.8%. Among the 90 surviving patients, only 36 (40%) had been weaned off ventilators at the time of discharge. Multivariate logistic regression analysis was used to identify underlying factors such as congestive cardiac failure (P = 0.009), initial high oxygenation index value (P = 0.04), increased SOFA scores (P = 0.01), and increased APACHE II scores (P = 0.02) as independent predictors of ventilator dependence. Results from the Kaplan-Meier method indicate that initial therapy with antibiotics could increase the ventilator weaning rate (log Rank test, P < 0.001). Conclusions. Preexisting cardiopulmonary function, high APACHE II and SOFA scores, and high oxygenation index were the strongest predictors of ventilator dependence. Initial empiric antibiotic treatment can improve ventilator weaning rates at the time of discharge.

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Section: Discussionmentioning

confidence: 99%

Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia

Tseng

Huang

Chen

et al. 2012

The Scientific World Journal

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“…Although there was no difference in overall mortality between those who received early and late enteral feeding, there was an excess mortality in those with aspiration pneumonia. Previous studies have shown that early enteral feeding can reduce mortality [22] and incidence of sepsis [3], hasten recovery [23] and shorten length of hospital stay [24], but all these studies were done in well-resourced settings, including round the clock availability of endotracheal intubation and mechanical ventilation. In the current study none of these potential benefits of early enteral feeding could be detected.…”

Section: Discussionmentioning

confidence: 99%

Timing of Enteral Feeding in Cerebral Malaria in Resource-Poor Settings: A Randomized Trial

et al. 2011

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BackgroundEarly start of enteral feeding is an established treatment strategy in intubated patients in intensive care since it reduces invasive bacterial infections and length of hospital stay. There is equipoise whether early enteral feeding is also beneficial in non-intubated patients with cerebral malaria in resource poor settings. We hypothesized that the risk of aspiration pneumonia might outweigh the potential benefits of earlier recovery and prevention of hypoglycaemia.Method and FindingsA randomized trial of early (day of admission) versus late (after 60 hours in adults or 36 hours in children) start of enteral feeding was undertaken in patients with cerebral malaria in Chittagong, Bangladesh from May 2008 to August 2009. The primary outcome measures were incidence of aspiration pneumonia, hypoglycaemia and coma recovery time. The trial was terminated after inclusion of 56 patients because of a high incidence of aspiration pneumonia in the early feeding group (9/27 (33%)), compared to the late feeding group (0/29 (0%)), p = 0.001). One patient in the late feeding group, and none in the early group, had hypoglycaemia during admission. There was no significant difference in overall mortality (9/27 (33%) vs 6/29 (21%), p = 0.370), but mortality was 5/9 (56%) in patients with aspiration pneumonia.ConclusionsIn conclusion, early start of enteral feeding is detrimental in non-intubated patients with cerebral malaria in many resource-poor settings. Evidence gathered in resource rich settings is not necessarily transferable to resource-poor settings.Trial RegistrationControlled-Trials.com ISRCTN57488577

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“…The total calorie goal was 20 to 25 kcal/kg in the acute phase of injury and 25 to 30 kcal/kg during I nadequate intake of calories and protein is a common problem in intensive care units (ICUs) [1][2][3][4] and results from a combination of a hypercatabolic state and a reduction in the nutrient supply. 5,6 The reduced nutrient supply may be due to an underestimation of the amount of calories and protein needed [7][8][9][10] or to the difference between the number of calories prescribed and the number received. The percentage of prescribed calories that is actually received varies between 51% and 99%.…”

Section: Methodsmentioning

confidence: 99%

Nurse to Bed Ratio and Nutrition Support in Critically Ill Patients

Honda

Freitas

Stanich

et al. 2013

American Journal of Critical Care

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Background Inadequate nutrition support is common among critically ill patients, and identification of risk factors for such inadequacy might help in improving nutrition support. Objective To determine how often daily calorie goals are met and the factors responsible for inadequate nutrition support. Methods A single-center prospective cohort study. Each patient's demographic and clinical characteristics, the need for ventilatory support, the use and dosage of medications, the number of nursing staff per bed, the time elapsed from admission to the intensive care unit until the effective start of enteral feeding, and the causes for nonadministration were recorded. Achievement of daily calorie goals was determined and correlated with risk factors. Results A total of 262 daily evaluations were done in 40 patients. Daily calorie goal was achieved in only 46.2% of the evaluations (n = 121), with a mean of 74.8% of the prescribed volume of enteral nutrition infused daily. Risk factors for inadequate nutrition support were the use of midazolam (odds ratio, 1.58; 95% CI, 1.18-2.11) and fewer nursing professionals per bed (odds ratio, 2.56; 95% CI, 1.43-4.57). Conclusion Achievement of daily calorie goals was inadequate, and the main factors associated with this failure were the use and dosage of midazolam and the number of nurses available.

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Early vs Delayed Enteral Nutrition in Critically Ill Medical Patients

Cited by 33 publications

References 20 publications

Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia

Factors Predicting Ventilator Dependence in Patients with Ventilator-Associated Pneumonia

Timing of Enteral Feeding in Cerebral Malaria in Resource-Poor Settings: A Randomized Trial

Nurse to Bed Ratio and Nutrition Support in Critically Ill Patients

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