Jayshil J Patel1, Michelle Kozeniecki2, Annie Biesboer3, William Peppard4, Ananda S Ray5, Seth Thomas4, Elizabeth R Jacobs6, Rahul Nanchal7, Gagan Kumar6. 1. Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA japatel@mcw.edu. 2. Department of Nutrition Services, Medical College of Wisconsin, Milwaukee, WI, USA. 3. Department of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, WI, USA. 4. Department of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, USA. 5. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA. 6. Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Clement J. Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, WI, USA. 7. Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
Abstract
PURPOSE: Current guidelines provide weak recommendations for starting enteral nutrition (EN) in patients with septic shock (on vasopressor support). Outcomes of patients receiving EN in septic shock on vasopressor support have not been well studied. We hypothesize that early trophic EN in mechanically ventilated patients with septic shock is associated with improved outcomes. METHODS: Single-center retrospective study of mechanically ventilated patients admitted with septic shock to identify patients receiving (1) no EN, (2) <600 kcal/d within 48 hours, and (3) ≥600 kcal/d within 48 hours. Outcomes studied included in-hospital mortality, length of intensive care unit stay (LOS), duration of mechanical ventilation (DOMV), and complications of feeding intolerance. RESULTS: Sixty-six patients were identified. In all, 15 received no EN, 37 received <600 kcal/d, and 14 received ≥600 kcal/d EN daily. Median LOS was 12, 5, and 13 days, respectively. The LOS was lower in patients receiving <600 kcal/d when compared to either no EN (P < .001) or those receiving ≥600 kcal/d (P < .001). Median DOMV was lower in patients receiving <600 kcal/d (median 3, P < .001) as compared to no EN (median 7, P < .001) or those receiving ≥600 kcal/d (median 7.5, P < .001). Mortality was not different. There were no significant complications among groups. CONCLUSION: In patients with septic shock, those receiving <600 kcal/d EN within 48 hours had lower DOMV and LOS when compared to those who did not receive EN or those who received ≥600 kcal/d. These observations provide strong justification for prospective evaluation of the effect of early trophic EN in patients with septic shock.
PURPOSE: Current guidelines provide weak recommendations for starting enteral nutrition (EN) in patients with septic shock (on vasopressor support). Outcomes of patients receiving EN in septic shock on vasopressor support have not been well studied. We hypothesize that early trophic EN in mechanically ventilated patients with septic shock is associated with improved outcomes. METHODS: Single-center retrospective study of mechanically ventilated patients admitted with septic shock to identify patients receiving (1) no EN, (2) <600 kcal/d within 48 hours, and (3) ≥600 kcal/d within 48 hours. Outcomes studied included in-hospital mortality, length of intensive care unit stay (LOS), duration of mechanical ventilation (DOMV), and complications of feeding intolerance. RESULTS: Sixty-six patients were identified. In all, 15 received no EN, 37 received <600 kcal/d, and 14 received ≥600 kcal/d EN daily. Median LOS was 12, 5, and 13 days, respectively. The LOS was lower in patients receiving <600 kcal/d when compared to either no EN (P < .001) or those receiving ≥600 kcal/d (P < .001). Median DOMV was lower in patients receiving <600 kcal/d (median 3, P < .001) as compared to no EN (median 7, P < .001) or those receiving ≥600 kcal/d (median 7.5, P < .001). Mortality was not different. There were no significant complications among groups. CONCLUSION: In patients with septic shock, those receiving <600 kcal/d EN within 48 hours had lower DOMV and LOS when compared to those who did not receive EN or those who received ≥600 kcal/d. These observations provide strong justification for prospective evaluation of the effect of early trophic EN in patients with septic shock.
Authors: Gabriela Quiroz-Olguín; Gabriela Gutiérrez-Salmeán; Juan G Posadas-Calleja; María F Padilla-Rubio; Aurora E Serralde-Zúñiga Journal: Eur J Clin Nutr Date: 2021-02-19 Impact factor: 4.016
Authors: Craig M Coopersmith; Daniel De Backer; Clifford S Deutschman; Ricard Ferrer; Ishaq Lat; Flavia R Machado; Greg S Martin; Ignacio Martin-Loeches; Mark E Nunnally; Massimo Antonelli; Laura E Evans; Judith Hellman; Sameer Jog; Jozef Kesecioglu; Mitchell M Levy; Andrew Rhodes Journal: Intensive Care Med Date: 2018-07-03 Impact factor: 17.440