Bhuvaneshwari Shankar1, D K Daphnee2, Nagarajan Ramakrishnan3, Ramesh Venkataraman4. 1. Department of Dietetics, Apollo Hospitals, Chennai, India. Electronic address: bhuvaneshwari_s@apollohospitals.com. 2. Department of Dietetics, Apollo Hospitals, Chennai, India. Electronic address: daphnee_dk@apollohospitals.com. 3. Department of Critical Care Medicine, Apollo Hospitals, Chennai, India. Electronic address: icudoctor@gmail.com. 4. Department of Critical Care Medicine, Apollo Hospitals, Chennai, India. Electronic address: ccmramesh@gmail.com.
Abstract
BACKGROUND: In critically ill patients, early enteral nutrition (EN) within 24 to 72 hours is recommended. Although vasopressor-dependent shock after resuscitation is not a contraindication for EN initiation, feasibility and safety of very early (within 6 hours) EN initiation soon after resuscitation are unknown. OBJECTIVE: To evaluate the feasibility, safety, tolerance, and adequacy of very EN delivery in critically ill patients within 6 hours of intensive care unit (ICU) admission. MATERIAL AND METHODS: Prospectively collected data from a total of 308 medical and surgical patients admitted to the ICU for at least 3 days were analyzed. The patients in whom EN was initiated within 6 hours of ICU admission (n = 166) were compared with those in whom EN was initiated after 6 hours (n = 142). Comparisons were made between groups in the percentage of target calories and proteins delivered on day 3, percentages of patients achieving target calories and proteins on day 3, incidence of feed intolerance, ICU length of stay (LOS), hospital LOS, ICU/hospital discharge, and mortality. RESULTS: No significant differences were seen in percentage of calories (71.62% vs 71.83%; P = .09) and proteins (71.85% vs 68.89%; P = .2) delivered on day 3 between patients receiving EN within 6 hours and after 6 hours of admission. Similar number of patients achieved target calories (66.3% vs 67.6%; P = .8) and target proteins (66.9% vs 62.7%; P = .5) on day 3 in both groups. There were no significant differences between the groups for ICU LOS (11.41 days vs 11.72 days; P = .7) and hospital LOS (20.7 days vs 17.96 days; P = .1). A total of 77.1% patients were discharged in the group in whom EN was initiated within 6 hours and 67.6% patients were discharged in the group where EN was initiated after 6 hours (P = .07). The mortality rate was 22.9% and 32.4%, respectively (P = .07), in these groups. Overall incidence of EN interruption was 20.13% without significant difference between the 2 groups (<6 hours, 16.2%; >6 hours, 24.7%; P = .087). CONCLUSION: Initiation of EN within 6 hours of ICU admission is feasible and safe and can be implemented routinely in all ICU patients.
BACKGROUND: In critically illpatients, early enteral nutrition (EN) within 24 to 72 hours is recommended. Although vasopressor-dependent shock after resuscitation is not a contraindication for EN initiation, feasibility and safety of very early (within 6 hours) EN initiation soon after resuscitation are unknown. OBJECTIVE: To evaluate the feasibility, safety, tolerance, and adequacy of very EN delivery in critically illpatients within 6 hours of intensive care unit (ICU) admission. MATERIAL AND METHODS: Prospectively collected data from a total of 308 medical and surgical patients admitted to the ICU for at least 3 days were analyzed. The patients in whom EN was initiated within 6 hours of ICU admission (n = 166) were compared with those in whom EN was initiated after 6 hours (n = 142). Comparisons were made between groups in the percentage of target calories and proteins delivered on day 3, percentages of patients achieving target calories and proteins on day 3, incidence of feed intolerance, ICU length of stay (LOS), hospital LOS, ICU/hospital discharge, and mortality. RESULTS: No significant differences were seen in percentage of calories (71.62% vs 71.83%; P = .09) and proteins (71.85% vs 68.89%; P = .2) delivered on day 3 between patients receiving EN within 6 hours and after 6 hours of admission. Similar number of patients achieved target calories (66.3% vs 67.6%; P = .8) and target proteins (66.9% vs 62.7%; P = .5) on day 3 in both groups. There were no significant differences between the groups for ICU LOS (11.41 days vs 11.72 days; P = .7) and hospital LOS (20.7 days vs 17.96 days; P = .1). A total of 77.1% patients were discharged in the group in whom EN was initiated within 6 hours and 67.6% patients were discharged in the group where EN was initiated after 6 hours (P = .07). The mortality rate was 22.9% and 32.4%, respectively (P = .07), in these groups. Overall incidence of EN interruption was 20.13% without significant difference between the 2 groups (<6 hours, 16.2%; >6 hours, 24.7%; P = .087). CONCLUSION: Initiation of EN within 6 hours of ICU admission is feasible and safe and can be implemented routinely in all ICU patients.