The impact of early enteral nutrition on pediatric acute respiratory failure

Abstract

Children who are critically ill undergo metabolic stress and it is important that they receive adequate calories and protein in order to recover. Our objective was to investigate the impact of early enteral nutrition (EEN) on pediatric intensive care (PICU) patients with acute respiratory failure. A retrospective cohort study was performed on all patients admitted to a 20 bed PICU at a tertiary children's hospital over a 30 month period. Inclusion criteria were: intubation on admission or within 24h of admission, ventilation over 48h and enteral nutrition initiated on ventilatory support. Baseline patient characteristics and nutritional, ventilatory and overall outcome data were collected. Subgroup analysis was performed comparing those that received EEN (goal in 72h) and those that did not. Patients that received EEN had a shorter PICU and overall length of stay 8.7 vs 10.7 and 17.5 vs 22; p<0.05 and received a higher percentage of goal Kcal and protein (71 vs 54, and 61 vs 51%, p<0.002) in the PICU. After adjusting for age and severity of illness, EEN was still associated with decreased PICU and overall length of stay. More patients with feeding intolerance were on vasoactive agents (33 vs 9%, p=0.02), but intolerance was not associated with use of motility agents or degree of respiratory failure. Feeds were interrupted in 19% of patients, most commonly for procedures. In PICU patients with acute respiratory failure, EEN is associated with shorter PICU and overall length of stay and delivery of higher percentage of goal Kcal and protein by tube feeds. Feeds are commonly interrupted despite efforts to achieve EEN and patients receiving vasoactive agents have feeds held more commonly for perceived intolerance.