Effects of Early Enteral Nutrition on Immune Function and Prognosis of Patients With Sepsis on Mechanical Ventilation

Abstract

Objective: To explore the therapeutic effects of early enteral nutrition (EEN) on patients with sepsis on mechanical ventilation. Methods: Patients with sepsis on mechanical ventilation in the medical intensive care unit (ICU) from January 2013 to March 2016 were treated with enteral nutrition. Patients treated within 48 hours of initiation of mechanical ventilation were assigned to the EEN group, and the rest were assigned to the delayed enteral nutrition (DEN) group. Peripheral blood Th17 cells and Treg cells, endotoxin (ET) level, 28-day mortality, duration of mechanical ventilation, lengths of ICU stay and hospital stay, and incidence of ICU-acquired weakness (ICU-AW) were analyzed between the 2 groups. Results: The proportion of Th17 cells and ET levels in the EEN group were significantly lower than those in the DEN group, whereas the proportion of Treg cells in the EEN group was remarkably higher than that in the DEN group ( P < .05). The duration of mechanical ventilation, lengths of ICU stay and hospital stay, and incidence of ICU-AW were higher in the DEN group than in the EEN group ( P < .05), but there was no significant difference in the 28-day mortality between the 2 groups. Conclusion: Patients with sepsis mainly present with an increased proportion of Th17 cells in the early stage, manifesting as enhanced immune response. Early enteral nutrition can inhibit the excessive immune response, shorten the duration of mechanical ventilation, lengths of ICU stay and hospital stay, and reduce the incidence of ICU-AW, but it has no obvious effect on 28-day mortality.

Nutritional Interventions on Physical Functioning for Critically Ill Patients: An Integrative Review

“…Key databases were searched up until March 2016 to identify studies that measured skeletal muscle mass and/or total body protein (TBP) at 2 or more time points during acute critical illness (up to 2 weeks after an ICU stay). Muscle mass 1) The association between energy and protein delivery and changes in skeletal muscle mass - ≠ I 7) Liu et al 39 2018 China 28 days Single-center Non-randomized control trial N = 63 Within 48 hours of ICU admission Provider unspecified Mechanically ventilated with sepsis - Experimental group: early enteral nutrition (EN): receive enteral nutrition treatment within 48 hours of being admitted to ICU. The target calories and protein contents in this study were 25 kcal/kg/d (Ideal body weight) and 1.2 g/kg/d, respectively.…”

“…Among the seven intervention trials identified, the energy targets of six were individualized, namely using equations (the Harris-Benedict equation, 35 the Quark RMR Indirect Calorimeter, 36 and the modified Penn State Equation 37 in three trial respectively), indirect calorimetry (around 25 kcal/kg/d (24 kcal/kg/d for the higher protein group, 26 kcal/kg/d for the lower protein group), 38 25–30 kcal/kg/d (25 kcal/kg/d initially) 39 and 1.5 kcal/kg/h 40 ) in three trials respectively, etc. to dynamically measure individuals’ energy targets.…”

Determination of Cutoff Point of an Early Energy Target to Maximize Better Clinical Outcomes in SCU Patients with Cerebral Hemorrhage

“…The nutritional route, parenteral vs. enteral, or oral, must be considered to achieve better outcomes. In general, an enteral nutritional route has been reported to enhance immunity to prevent infectious events [17]. A nutritional management through enteral route decreases infectious complications and LOS in SCU [18].…”

Effect of early activity combined with early nutrition on acquired weakness in ICU patients

“…[ 12 , 13 ] Several studies have explored the influence of early nutrition on ICU-AW. [ 14 – 16 ] A randomized controlled trial (RCT) showed a relationship between early enteral nutrition (EN) and reduced weakness. [ 14 ] Early nutrition can suppress the extent of tissue damage caused by the inflammatory response by inhibiting excessive immune responses.…”

“…[ 14 – 16 ] A randomized controlled trial (RCT) showed a relationship between early enteral nutrition (EN) and reduced weakness. [ 14 ] Early nutrition can suppress the extent of tissue damage caused by the inflammatory response by inhibiting excessive immune responses. [ 12 ] However, a multicenter RCT found that the implementation of early parenteral nutrition (PN) was related to increased weakness.…”