Continuation of enteral nutrition until extubation in critically ill patients.

Abstract

There is substantial variation in enteral nutrition practices for airway procedures in critically ill patients across individual specialists and intensive care units (ICUs). Fasting times can vary between 0 h and longer than 24 h before planned extubations. 1 Varghese JA Tatucu-Babet OA Miller E et al. Fasting practices of enteral nutrition delivery for airway procedures in critically ill adult patients: a scoping review. J Crit Care. 2022; 72154144 Crossref PubMed Scopus (0) Google Scholar Patients receiving mechanical ventilation are often underfed, and interruptions are one of the main causes that energy prescriptions are not met. 2 Torrini F Gendreau S Morel J et al. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. Crit Care. 2021; 25: 391 Crossref PubMed Scopus (11) Google Scholar Airway procedures, such as extubation or tracheotomy, lead to the longest fasting periods in the ICU, but the implementation of unit-wide guidelines can reduce fasting time and maximise caloric intake. 3 Segaran E Barker I Hartle A Optimising enteral nutrition in critically ill patients by reducing fasting times. J Intensive Care Soc. 2016; 17: 38-43 Crossref PubMed Scopus (26) Google Scholar , 4 Hoffmann M Schwarz CM Fürst S et al. Risks in management of enteral nutrition in intensive care units: a literature review and narrative synthesis. Nutrients. 2020; 13: 82 Crossref PubMed Scopus (4) Google Scholar However, most of this common practice comes from the theatre, and mainly preoperative fasting practice guidelines are being used with the hope of minimising the risk of aspiration in airway procedures. 5 Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017; 126: 376-393 Crossref PubMed Scopus (450) Google Scholar Patients are at increased risk of aspiration due to oropharyngeal dysfunction for several hours following extubation 6 Schefold JC Berger D Zürcher P et al. Dysphagia in mechanically ventilated ICU patients (DYnAMICS): a prospective observational trial. Crit Care Med. 2017; 45: 2061-2069 Crossref PubMed Scopus (95) Google Scholar and up to 20% of patients have to be reintubated within 7 days. 2 Torrini F Gendreau S Morel J et al. Prediction of extubation outcome in critically ill patients: a systematic review and meta-analysis. Crit Care. 2021; 25: 391 Crossref PubMed Scopus (11) Google Scholar A question that remained unanswered was whether it is really safe to continue enteral nutrition until attempting to extubate. Continued enteral nutrition until extubation compared with fasting before extubation in patients in the intensive care unit: an open-label, cluster-randomised, parallel-group, non-inferiority trialContinued enteral nutrition until extubation in critically ill patients in the intensive care unit was non-inferior to a 6-h fasting maximum gastric vacuity strategy comprising continuous gastric tube suctioning, in terms of extubation failure within 7 days (a patient-centred outcome), and thus represents a potential alternative in this population. Full-Text PDF