Early Goal Enteral Nutrition Associated with Decreased In-hospital Death in Mechanically Ventilated Critically Ill Adults: a Retrospective Cohort Study

Overview

Journal BMJ Open Respir Res

Date 2024 May 15

PMID 38749534

Authors

Camilla S Powierza

Margaret M Doyle

Katherine Wasden

Taylor A Intihar

Amy S Korwin

Shyoko Honiden

Melissa P Knauert

Affiliations

Soon will be listed here.

Abstract

Introduction: Early enteral nutrition (EN) in critically ill adult patients is thought to improve mortality and morbidity; expert guidelines recommend early initiation of EN in critically ill adults. However, the ideal schedule and dose of EN remain understudied.

Study Objective: Our objective was to evaluate the relationship between achieving 70% of recommended EN within 2 days of intubation ('early goal EN') and clinical outcomes in mechanically ventilated medically critically ill adults. We hypothesised that early goal EN would be associated with reduced in-hospital death.

Methods: We conducted a retrospective cohort study of mechanically ventilated adult patients admitted to our medical intensive care unit during 2013-2019. We assessed the proportion of recommended total EN provided to the patient each day following intubation until extubation, death or 7 days whichever was shortest. Patients who received 70% or more of their recommended total daily EN within 2 days of intubation (ie, 'baseline period') were considered to have achieved 'early goal EN'; these patients were compared with patients who did not ('low EN'). The primary outcome was in-hospital death; secondary outcomes were successful extubation and discharge alive.

Results: 938 patients met eligibility criteria and survived the baseline period. During the 7-day postintubation period, 64% of all patients reached 70% of recommended daily calories; 33% of patients achieved early goal EN. In unadjusted and adjusted models, early goal EN versus low EN was associated with a lower incidence of in-hospital death (subdistribution HR (SHR) unadjusted=0.63, p=0.0003, SHR adjusted=0.73, p=0.02). Early goal EN was also associated with a higher incidence of successful extubation (SHR unadjusted=1.41, p<0.00001, SHR adjusted=1.27, p=0.002) and discharge alive (SHR unadjusted=1.54, p<0.00001, SHR adjusted=1.24, p=0.02).

Conclusions: Early goal EN was associated with significant improvement in clinical metrics of decreased in-hospital death, increased extubation and increased hospital discharge alive.

Citing Articles

Effectiveness and tolerance of enteral nutrition in critically ill patients with COVID-19.

Perez-Cruz E, Ortiz-Gutierrez S, Castanon-Gonzalez J, Luna-Camacho Y, Garduno-Lopez J Br J Nutr. 2024; 132(11):1446-1453.

PMID: 39497429 PMC: 11660160. DOI: 10.1017/S0007114524002666.

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