Faculty Collaboration Database

Early Trophic Enteral Nutrition Is Associated With Improved Outcomes in Mechanically Ventilated Patients With Septic Shock: A Retrospective Review. J Intensive Care Med 2016 Aug;31(7):471-7

Date

10/16/2014

Pubmed ID

25315218

DOI

10.1177/0885066614554887

Scopus ID

2-s2.0-84978069680 (requires institutional sign-in at Scopus site)   46 Citations

Abstract

PURPOSE: Current guidelines provide weak recommendations for starting enteral nutrition (EN) in patients with septic shock (on vasopressor support). Outcomes of patients receiving EN in septic shock on vasopressor support have not been well studied. We hypothesize that early trophic EN in mechanically ventilated patients with septic shock is associated with improved outcomes.

METHODS: Single-center retrospective study of mechanically ventilated patients admitted with septic shock to identify patients receiving (1) no EN, (2) <600 kcal/d within 48 hours, and (3) ≥600 kcal/d within 48 hours. Outcomes studied included in-hospital mortality, length of intensive care unit stay (LOS), duration of mechanical ventilation (DOMV), and complications of feeding intolerance.

RESULTS: Sixty-six patients were identified. In all, 15 received no EN, 37 received <600 kcal/d, and 14 received ≥600 kcal/d EN daily. Median LOS was 12, 5, and 13 days, respectively. The LOS was lower in patients receiving <600 kcal/d when compared to either no EN (P < .001) or those receiving ≥600 kcal/d (P < .001). Median DOMV was lower in patients receiving <600 kcal/d (median 3, P < .001) as compared to no EN (median 7, P < .001) or those receiving ≥600 kcal/d (median 7.5, P < .001). Mortality was not different. There were no significant complications among groups.

CONCLUSION: In patients with septic shock, those receiving <600 kcal/d EN within 48 hours had lower DOMV and LOS when compared to those who did not receive EN or those who received ≥600 kcal/d. These observations provide strong justification for prospective evaluation of the effect of early trophic EN in patients with septic shock.

Author List

Patel JJ, Kozeniecki M, Biesboer A, Peppard W, Ray AS, Thomas S, Jacobs ER, Nanchal R, Kumar G

Authors

Rahul Sudhir Nanchal MD Professor in the Medicine department at Medical College of Wisconsin
Jayshil Patel MD Associate Professor in the Medicine department at Medical College of Wisconsin
William J. Peppard PharmD Trauma/Surgical Critical Care Pharmacist in the Pharmacy department at Froedtert Hospital

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Critical Care
Critical Illness
Energy Intake
Enteral Nutrition
Female
Hospital Mortality
Humans
Intensive Care Units
Length of Stay
Linear Models
Male
Middle Aged
Practice Guidelines as Topic
Prognosis
Respiration, Artificial
Retrospective Studies
Shock, Septic
Treatment Outcome