Effect on mortality of early enteral nutrition in critically ill patients with COVID-19

Abstract

Background: Early enteral nutrition (EEN) has shown favorable clinical outcomes, such as lower risk of death, fewer frequency of infection and lower healthcare costs. Different societies recommend the provision of enteral nutrition within the first 24 to 48 hours of admission to the Intensive Care Unit in patients with COVID-19. Methods: Retrospective cohort study including adult patients with severe COVID-19 and orotracheal intubation. Demographic and clinical characteristics, as well as use of drugs with nutritional relevance, such as vasopressors and steroids, as well as biochemical results (serum electrolytes) were registered. EEN was defined as the provision of enteral feeding within the first 24-48 hours of invasive mechanical ventilation (IMV). The primary outcome was in-hospital all-cause mortality. Results: Overall, 404 patients were included in the study. EEN was achieved in 74% of all patients. EEN significantly reduced mortality in the bivariate model (RR 0.88, 95% CI 0.80 - 0.95) and in the multivariate model (adjusted OR 0.42, 95% CI 0.19 – 0.90). No differences in hospital length of stay and days on IMV in survivors were found. Conclusions: EEN was associated with a lower risk of death in critically ill patients with COVID-19. Additional studies are necessary to further clarify the effects of early enteral feeding on patient outcomes.