Early Enteral Nutrition and Outcomes of Critically Ill Patients Treated With Vasopressors and Mechanical Ventilation
Abstract
OBJECTIVE: To determine the effect of early enteral feeding on the outcome of critically ill medical patients whose hemodynamic condition is unstable. METHODS: Prospectively collected data in a multi-institutional medical intensive care unit database were analyzed retrospectively. A total of 1174 patients were identified who required mechanical ventilation for more than 2 days and were treated with vasopressor agents to support blood pressure. The patients were divided into 2 groups: those who received enteral nutrition (n = 707) within 48 hours of the start of mechanical ventilation, termed the early enteral nutrition group, and those who did not (n = 467), termed the late enteral nutrition group. The primary end points were overall intensive care unit and hospital mortality. Subgroup analyses were used to evaluate potential confounding variables. The data were also analyzed after adjustments for confounding by matching for propensity score. RESULTS: Intensive care unit and hospital mortality were lower in the early enteral nutrition group than in the late enteral group: 22.5% vs 28.3%; P = 03; and 34.0% vs 44.0%; P < .001, respectively. The beneficial effect of early feeding was more evident in the sickest patients, that is, those treated with multiple vasopressors (odds ratio, 0.36; 95% confidence interval, 0.15-0.85) and those without early improvement (odds ratio, 0.59; 95% confidence interval, 0.39-0.90). When adjustments were made for confounding by matching for propensity score, early feeding was associated with decreased hospital mortality. CONCLUSION: Early enteral nutrition may be associated with reduced intensive care unit and hospital mortality in patients whose hemodynamic condition is unstable.
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Only one outcome study in septic patients compared early enteral nutrition with energy target reached by day 3 after admission with late enteral nutrition and found no difference in survival or infection rate.
“Only one outcome study in septic patients compared “early” EN with energy target reached by the 3rd day after admission with “late” EN (no nutrition until day 3 after ICU admission) and found no difference (survival or infection rate) (326).”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [326]
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When can we start early enteral nutrition safely in patients with shock on vasopressors?
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- Authors
- Khalid, I., Doshi, P., & DiGiovine, B.
- Affiliations
- John D. Dingell VA Medical Center (US)
- ORCID
- Venue
- American Journal of Critical Care
- Publisher
- AACN Publishing
- Published
- 2010-04-30
- Volume
- 19
- Issue
- 3
- Pages
- 261-268
- ISSN
- 1062-3264 (ISSN-L)
- 1937-710X
- OpenAlex
- W2160868159
- Cited by
- 310
- References
- 2
- Citations by year
- 2026: 12 · 2025: 10 · 2024: 10 · 2023: 13 · 2022: 13 · 2021: 18 · 2020: 28 · 2019: 27 · 2018: 24 · 2017: 22 · 2016: 29 · 2015: 27 · 2014: 35 · 2013: 19 · 2012: 13
- FWCI
- 12.39
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Critical Care (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 › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- early enteral nutrition, mechanical ventilation, vasopressors, critically ill medical patients, ICU mortality, in-hospital mortality, hemodynamic instability, propensity score matching
- MeSH terms
- Critical Care, Enteral Nutrition, Female, Humans, Male, Middle Aged, Respiration, Artificial, Retrospective Studies, Severity of Illness Index, Vasoconstrictor Agents, Cohort Studies, Odds Ratio, Critical Illness, Treatment Outcome, Hospital Mortality
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