Is early enteral nutrition a risk factor for gastric intolerance and pneumonia?
Abstract
Background Early enteral nutrition (EN) after injury reduces septic complications, but upper digestive intolerance (UDI) occurring immediately post-trauma is a risk factor for pneumonia. Our study aimed to determine whether early intragastric feeding may lead to gastric intolerance and subsequent pneumonia in ventilated multiply injured patients. Methods This prospective study involved two groups of patients randomized either to immediate intragastric EN, or to delayed intragastric EN started later than 24 h after admission. UDI was diagnosed when gastric residual volume, measured with a 50-ml syringe after stopping the feeding for 2 h, exceeded 200 ml at least at two consecutive measurements, and/or when vomiting occurred. Results Out of 52 patients, 27 were included in the early EN group, and 25 in the delayed-EN group. On day 4, the early EN group received a greater amount of feeding because of intolerance problems occurring in the delayed-EN group (1175 +/- 485 ml vs. 803 +/- 545 ml). Twenty-five subjects--33% of the early EN patients and 64% of the delayed-EN patients--met the criteria for pneumonia (P = 0.050). On average, patients with pneumonia were older, more severely injured, and therefore required more ventilator days and a longer stay in the intensive care unit than patients without pneumonia. Conclusions If properly administered, early enteral nutrition can decrease the incidence of upper intestinal intolerance and nosocomial pneumonia in patients with multiple injuries.
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Use of EN during the first 48 h after admission in patients with uncontrolled shock was shown to be less favorable in terms of survival than its delayed use (48 h after admission) in patients with successful resuscitation and stable hemodynamic parameters.
“The use of EN during the first 48 h after admission in patients with uncontrolled shock was shown to be less favorable in terms of survival than its delayed use (48 h after admission) in patients with successful resuscitation and stable hemodynamic parameters (332).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [332]
Kompan et al. compared early EN to early PN followed by EN in multiple trauma patients and found a significant decrease in pneumonia and length of stay, but not in hospital stay and mortality.
“Kompan et al. [124] compared early EN to early PN followed by EN in multiple trauma patients and found a significant decrease in pneumonia and length of stay, but not in hospital stay and mortality.”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [124]
Cites
Early versus late enteral feeding of mechanically ventilated patients: Results of a clinical trial.
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McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
McClave, S. A., Martindale, R. G., Vanek, V. W., McCarthy, M., Roberts, P., Taylor, B., Ochoa, J. B., Napolitano, L., Cresci, G., the A.S.P.E.N. Board of Directors, et al. (2009) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607109335234 · Cited by 1,873 · see citing works
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001525 · Cited by 1,476 · see citing works
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
BLASER, A. R., STARKOPF, J., KIRSIMÄGI, Ü., & DEANE, A. M. (2014) · Acta Anaesthesiologica Scandinavica · doi:10.1111/aas.12302 · Cited by 231 · see citing works
Tian, F., Heighes, P. T., Allingstrup, M. J., & Doig, G. S. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003152 · Cited by 147 · see citing works
- Authors
- Kompan, L., Vidmar, G., Spindler-Vesel, A., & Pec̆ar, J.
- Affiliations
- University of Ljubljana (SI)
- Corresponding author
- Kompan, Lidija
- ORCID
- Vidmar, Gaj
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2004-08
- Volume
- 23
- Issue
- 4
- Pages
- 527-532
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2073013412
- Cited by
- 105
- References
- 2
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 2 · 2022: 4 · 2021: 3 · 2020: 7 · 2019: 7 · 2018: 5 · 2017: 4 · 2016: 6 · 2015: 6 · 2014: 10 · 2013: 8
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
- Keywords
- early enteral nutrition, delayed enteral nutrition, gastric intolerance, nosocomial pneumonia, polytrauma, mechanically ventilated patients, gastric residual volume, vomiting, ICU length of stay
- MeSH terms
- Adult, Age Factors, Cross Infection, Enteral Nutrition, Female, Gastrointestinal Diseases, Humans, Intensive Care Units, Length of Stay, Male, Multiple Trauma, Pneumonia, Prospective Studies, Risk Factors, Time Factors, Trauma Severity Indices, Risk Assessment
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