Nutritional support has emerged as an essential component in the management of critically ill patients. Previous studies that have shown a beneficial outcome of early enteral feeding were done in post-operative surgical, burn and severely injured trauma patients. However, the optimal time to start enteral nutrion in critically ill medical patients is unclear with a recent study suggesting that early feeding leads to increased infectious complications. The aim of our study was to evaluate the effect of early feeding on the mortality of critically ill medical patients.METHODS: The study was a retrospective analysis of 4,389 mechanically-ventilated medical patients from intensive care units across the country included in the Project Impact database (version 3).
We had 4,389 patients of whom 2,689 (61%) received enteral feeding within 2 days of intubation(early-feeding group) and 1,700 (39%) who were not fed within this time period (late-feeding group). Patients in the early feeding group were older (mean age was 62.4 versus 60.1, p=0.0001) but were less severely ill (mean APACHE II score was 20.6 versus 21.2, p=0.038). The absolute ICU mortality rate was lower in the early feeding group (18.6% versus 22.8%, p=0.001) as was the hospital mortality (29.5% versus 34.6%, p=0.001). There was no difference in the rates of hospital acquired pneumonia, gastrointestinal bleeding, or ICU length of stay between the two groups. Even after correcting for severity of illness and age in a multivariate analysis, early feeding was associated with a decreased risk of death in the ICU(OR: 0.80 (95% CI: 0.67-0.95)) and the hospital (OR: 0.76 [95% CI: 0.65-0.89]).CONCLUSIONS: Administration of early enteral feeding in critically ill patients is independently associated with a lower ICU and hospital mortality rate. Early feeding strategy did not impact the rates of hospital acquired pneumonia or gastrointestinal bleeding.
The results of our study support the importance of early enteral feeding in mechanically ventilated critically ill patients.
V. Artinian, None.