PURPOSE: To determine the impact of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients who are on vasopressors.
METHODS: Retrospective analysis of prospectively collected multi-institutional intensive care unit database of 1,174 patients requiring mechanical ventilation and vasopressor medications.
RESULTS: All patients were on vasopressors for at least 1 day, they were then divided according to whether or not they received enteral feeding within 48 hours of onset of mechanical ventilation. The 707 patients (60%) who did were labeled as the “early feeding group” and the remaining 467 patients (40%) were labeled as the “late feeding group”. The overall ICU and hospital mortality was lower in the early feeding group (22.5% versus 28.3%, p=0.03 and 34% versus 44%, p=0.0006, respectively). The lower mortality rates in the early feeding group were more evident in the sickest group as defined by quartiles of severity illness scores. Three separate models were done using each of the different scores (APACHE-II, SAPS-II and MPM-0). In all models, early enteral feeding was associated with an approximately 20% decrease in ICU mortality and 25% decrease in hospital mortality, even in light of vasopressor use. We also analyzed the data after controlling for confounding by matching for propensity score. In this analysis, early feeding was again associated with decreased ICU and hospital mortality. In all adjusted analysis, early feeding was not found to be associated with an increased risk of developing Ventilator associated pneumonia (VAP).
CONCLUSION: Early feeding significantly reduces overall ICU and hospital mortality even in light of vasopressor use, especially in the sickest patients. Routine administration of such therapy in mechanically ventilated patients independent of vasopressor use is suggested, especially in patients at high risk of death.
CLINICAL IMPLICATIONS: Administration of enteral feeding is a simple intervention which can be instituted in critically ill patients and appears to be beneficial interms of both hospital and ICU mortality. So it should be routinely administered in all critically ill mechanically ventilated patients.
DISCLOSURE: Pratik Doshi, None.