Comparison of the Initiation Time of Enteral Nutrition for Critically Ill Patients: At Admission vs. 24 to 48 Hours after Admission

Emergency Medicine International
-
Sep 2021
Citations:19
Influential Citations:1
Interventional (Human) Studies
81
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Methods
Design: prospective, randomized, parallel-controlled, single-blind interventional clinical trial. Participants: critically ill adult ICU patients admitted between January 2017 and December 2018; completed n=87 (intervention n=44, control n=43); age 15–88 years (mean 56.8 ± 16.8); sexes: 59 male, 28 female; inclusion: admitted to general adult ICU, age ≥14, informed consent; exclusion: hemodynamic instability or contraindications to enteral nutrition.
Intervention
Enteral nutrition using Nutrison Fibre (1 kcal/mL) started immediately via nasojejunal tube in the intervention group; initial continuous infusion at 20 mL/h via feeding pump; aim for 30 kcal/kg/day within 2 days by increasing rate by 20 mL/h as tolerated based on gastric residuals checked every 4 hours; escalate when aspirated gastric contents are ≤150 mL or less than the volume infused over 4 hours; if gastric residuals indicate intolerance (gastric retention) or diarrhea/vomiting occurs, infusion rate is reduced by 50%; feeding terminated if intolerance persists after adjustments; duration not specified.
Results
Immediate initiation of enteral nutrition at ICU admission via nasojejunal tube improved nutritional status and several clinical outcomes versus initiation at 24–48 hours via gastric tube. Intervention group had higher serum albumin and prealbumin (P<0.05); ICU stay and ventilator time were shorter (P<0.05); lower incidences of gastric retention, reflux, and pulmonary infection (P<0.05). Authors conclude that, in the absence of contraindications, EN can be started immediately at admission (within 6 hours) with nasojejunostomy to improve nutrition and prognosis, shorten ICU stay and ventilator use, and reduce complications.
Limitations
Small, single-center trial; 87 participants; short follow-up (up to 14 days); generalizability limited; some withdrawals not long-term outcomes.

Abstract

Objective To investigate the better time of initiation of enteral nutrition for critically ill patients, such as at admission or 24 to 48 hours after admission. Methods This was a prospective, randomized, parallel-controlled, single-blind, interventi...