Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial.

Multicenter randomized trial at 44 hospitals in the NHLBI ARDS Clinical Trials Network. Adults with acute lung injury who required mechanical ventilation and were enrolled within 48 hours of ALI onset were assigned to trophic feeding (N=508) or full feeding (N=492).

Adults with acute lung injury were randomized to initial trophic enteral feeding or full enteral feeding. The trophic group received 10 mL/h (about 10-20 kcal/h) initially, later 20 kcal/h after the omega-3 portion was stopped, with advancement to full-energy feeding if still ventilated at 144 hours; the full-feeding group started at 25 mL/h and advanced toward 25 to 30 kcal/kg/day of nonprotein calories plus 1.2 to 1.6 g/kg/day of protein.

Initial trophic feeding did not improve the main clinical outcomes compared with full feeding. Ventilator-free days through day 28 were essentially identical: 14.9 versus 15.0, difference -0.1 (95% CI, -1.4 to 1.2; P=.89), and 60-day mortality was also similar at 23.2% versus 22.2% (difference 1.0%, 95% CI, -4.1% to 6.3%; P=.77). Trophic feeding produced fewer gastrointestinal intolerance events, including regurgitation, vomiting, elevated gastric residual volumes, and constipation, but diarrhea, aspiration, and abdominal distention were not meaningfully different. Time to reach goal feeding was longer with trophic feeding (6.7 vs 1.3 days), and net fluid balance by day 7 was lower.

The intervention was short-term and focused on the first 6 days of ventilation, so it does not address longer-term feeding strategies. The study population was restricted to mechanically ventilated adults with acute lung injury at specialized centers, limiting generalizability. Some early patients in the trophic arm also received an omega-3 component before that portion was stopped, which adds complexity to interpreting the active regimen.