Early nutritional support is associated with improved outcomes in respiratory failure (original) (raw)

2010, Acta Medica Academica

Objective. To evaluate early feeding as a predictor of outcome in critically ill patients receiving prolonged mechanical ventilation. Patients and methods. A retrospective cohort study in four medical, surgical and multidisciplinary intensive care units (ICU) in a tertiary referral center of adult patients requiring at least 48 hours of mechanical ventilation. Early feeding was defined as any nutritional support (enteral or parenteral) for at least 6 hours, started within 48 hours of mechanical ventilation. The primary endpoint was hospital mortality. The secondary endpoints were length of stay, and duration of mechanical ventilation. Univariate and multivariate analysis were used as appropriate. Results. 394 out of 4,546 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 hospital mortality 36 % (33-39); ICU mortality 19%, hospital mortality 28%, 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 reduced Standardized Mortality Ratio (number of observed hospital deaths/number of expected hospital deaths) of 0.53. When adjusted for various confounding factors such as severity of illness, trauma, route of feeding, post-operative state or the use of vasopressors, early feeding remained independently associated with 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 mortality in patients receiving prolonged (more than 48 hours) invasive mechanical ventilation.

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