Early nutritional support is associated with improved outcomes in respiratory failure
Keywords:Respiratory insufficiency, Enteral nutrition, Parenteral nutrition, Assessment, Patient outcome.
AbstractObjective. To evaluate early feeding as a predictor of outcomein critically ill patients receiving prolonged mechanicalventilation. Patients and methods. A retrospective cohortstudy in four medical, surgical and multidisciplinary intensivecare units (ICU) in a tertiary referral center of adult patientsrequiring at least 48 hours of mechanical ventilation.Early feeding was defined as any nutritional support (enteralor parenteral) for at least 6 hours, started within 48 hours ofmechanical ventilation. The primary endpoint was hospitalmortality. The secondary endpoints were length of stay, andduration of mechanical ventilation. Univariate and multivariateanalysis were used as appropriate. Results. 394 out of4,546 patients admitted to the ICU were studied. Age (mean:95% confidence interval was 62 (60-63); female gender 43%;APACHE III 72 (70-75); APACHE III predicted hospitalmortality 36 % (33-39); ICU mortality 19%, hospital mortality28%, ventilation –free days 41 (39-44). Only 11% (3%enteral, 8% parenteral) were fed on day 1, 55% (30% enteral,25% parenteral) on day 4, and 88% (51% enteral, 37% parenteral)on day 7. Early feeding was associated with a reducedStandardized Mortality Ratio (number of observed hospitaldeaths/number of expected hospital deaths) of 0.53. Whenadjusted for various confounding factors such as severity ofillness, trauma, route of feeding, post-operative state or theuse of vasopressors, early feeding remained independently associatedwith decreased hospital mortality (Odd Ratio 0.51;95% confidence interval 0.26-0.98; p = 0.042). Conclusion.Early nutrition is associated with decreased hospital mortalityin patients receiving prolonged (more than 48 hours) invasivemechanical ventilation.
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