Early vs delayed enteral nutrition in critically ill medical patients.

This study was conducted to identify current practice in provision of enteral nutrition (EN) and to determine effects of early enteral nutrition (EEN) on length of stay in the medical intensive care unit (ICU). In this prospective, observational study, medical ICU patients were evaluated to determine their candidacy for EEN. If patients were candidates for EN and expected to remain nothing-by-mouth for 48 hours, they were classified as receiving EEN (within 24 hours of admission) or delayed EN. Thirty-six patients were candidates for EEN. Eighteen received EEN and 18 received delayed EN. In the delayed group, the median time to start of EN was 2.1 +/- 4.8 days. Median ICU length of stay was 4.7 +/- 3.5 days in the EEN group compared with 8.5 +/- 8.3 days in the delayed group. Although hospital length of stay was shorter in the EEN group, this was not statistically significant (10.4 +/- 6.9 vs 16.9 +/- 11.5 days). Time on the ventilator was significantly shorter in the EEN group vs delayed (n = 30, 3.0 +/- 4.2 vs 6.0 +/- 9.2 days). The incidence of new pneumonia was lower in the EEN group (5.5% vs 44%), but no difference was found in the incidence of bacteremia. Hospital mortality was lower in the EEN group (1 vs 7 deaths). Given its association with numerous benefits, EEN within 24 hours of admission should be encouraged and implemented by clinicians in medical ICU patients, but additional research is needed.

[1]  Roy Ilan,et al.  Knowledge translation in critical care: Factors associated with prescription of commonly recommended best practices for critically ill patients* , 2007, Critical care medicine.

[2]  R. Andersson,et al.  Early Nasogastric Feeding in Predicted Severe Acute Pancreatitis: A Clinical, Randomized Study , 2006, Annals of surgery.

[3]  B. Digiovine,et al.  Effects of Early Enteral Feeding on the Outcome of Critically Ill Mechanically Ventilated Medical Patients , 2006 .

[4]  D. Heyland,et al.  Nutrition and infection in the intensive care unit: what does the evidence show? , 2005, Current opinion in critical care.

[5]  T. Rice,et al.  Variation in enteral nutrition delivery in mechanically ventilated patients. , 2005, Nutrition (Burbank, Los Angeles County, Calif.).

[6]  M. Gupta,et al.  Early Enteral Feeding by Nasoenteric Tubes in Patients with Perforation Peritonitis , 2005, World Journal of Surgery.

[7]  L. Kompan,et al.  Is early enteral nutrition a risk factor for gastric intolerance and pneumonia? , 2004, Clinical nutrition.

[8]  Kara E. Flavin,et al.  Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol. , 2004, Chest.

[9]  W. Sibbald,et al.  Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). , 2004, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[10]  Leah Gramlich,et al.  Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. , 2003, JPEN. Journal of parenteral and enteral nutrition.

[11]  C. Winkelman,et al.  Special Feature: Exploring the Benefits and Myths of Enteral Feeding in the Critically Ill , 2002, Critical care nursing quarterly.

[12]  P. Marik,et al.  Early enteral nutrition in acutely ill patients: A systematic review , 2001, Critical care medicine.

[13]  R. Nelson,et al.  Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. , 1999, Critical care medicine.

[14]  D. Spain,et al.  Enteral tube feeding in the intensive care unit: factors impeding adequate delivery. , 1999, Critical care medicine.

[15]  F. Cerra,et al.  Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. , 1997, Chest.

[16]  T. Fabian,et al.  A randomized trial of isonitrogenous enteral diets after severe trauma. An immune-enhancing diet reduces septic complications. , 1996, Annals of surgery.

[17]  J Marrugat,et al.  Effect of malnutrition after acute stroke on clinical outcome. , 1996, Stroke.

[18]  A. Valerio,et al.  Very early nutrition supplementation in burned patients. , 1990, The American journal of clinical nutrition.

[19]  E. Moore,et al.  Benefits of immediate jejunostomy feeding after major abdominal trauma--a prospective, randomized study. , 1986, The Journal of trauma.