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Retrospective Analysis of Early Enteral Feeding in Critically-Ill Patients With Septic Shock FREE TO VIEW

Jayshil Patel, MD; Michelle Kozeniecki, MS; Ananda Ray, MD; Annie Biesboer, PharmD; Seth Thomas, PharmD; William Peppard, PharmD; Gagan Kumar, MD
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Medical College of Wisconsin, Milwaukee, WI

Chest. 2013;144(4_MeetingAbstracts):415A. doi:10.1378/chest.1690103
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SESSION TITLE: Sepsis and Shock Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 30, 2013 at 01:30 PM - 02:30 PM

PURPOSE: Early enteral nutritional (EN) is recommended in critically-ill patients. The American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines provide grade-E recommendation for EN to be withheld in septic shock. Outcomes of patients receiving EN in septic shock have not been well-studied. We hypothesize that early EN in septic shock is associated with better outcomes.

METHODS: We performed a retrospective analysis of mechanically ventilated patients admitted with septic shock from April 2011-May 2012. We divided patients into 3 groups: (1)No enteral feeding (2)< 600 calories within 48-hours (3)≥600 calories within 48-hours. Outcomes studied were in-hospital mortality, length of ICU stay (LOICU), and duration of mechanical ventilation (DOMV). Chi-square test was used to compare categorical variables. Wilcoxan rank-test was used to compare the outcomes between continuous variables. Log-transformation was performed to convert LOICU stay and DOMV to normal distribution. LOICU stay and DOMV were adjusted for age, APACHE-II score, Charlson co-morbidity index, highest lactate levels, amount of fluid resuscitation, and body mass index.

RESULTS: There were 66 patients identified. Fifteen received no EN, 37 received <600 calories EN daily, and 14 received ≥600 calories EN daily. The mortality was 33.3%, 21.6%, and 21.4%, respectively, and not statistically significant. Median LOICU stay was 12 days, 5 days, and 13 days, respectively. On adjusted analysis, the LOICU stay was significantly lower in patients receiving <600 calories when compared to either no nutrition (p<0.001) or those receiving ≥600 calories (p<0.001). The median DOMV was significantly lower in those receiving <600 calories (median 3, p<0.001) as compared to those receiving no nutrition (median 7, p<0.001) or those receiving ≥600 calories (median 7.5, p<0.001).

CONCLUSIONS: In patients with septic shock, those receiving < 600 calories EN daily within 48-hours had lower DOMV and LOICU stay when compared to those who did not receive EN or those who received ≥600 calories. There was no difference in mortality.

CLINICAL IMPLICATIONS: Mechanically ventilated patients with septic shock may benefit from <600 calories early EN.

DISCLOSURE: The following authors have nothing to disclose: Jayshil Patel, Michelle Kozeniecki, Ananda Ray, Annie Biesboer, Seth Thomas, William Peppard, Gagan Kumar

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