Early Early Enteral Nutrition Research Articles

Early versus delayed enteral nutrition in ICU patients with sepsis: a propensity score-matched analysis based on the MIMIC-IV database.

Early enteral nutrition (EN) is recommended for sepsis management, but its optimal timing and clinical benefits remain uncertain. This study evaluates whether early EN improves outcomes compared to delayed EN in patients with sepsis. We analyzed data of septic patients from the MIMIC-IV 2.2 database, focusing on those in the Medical Intensive Care Unit (MICU) and Surgical Intensive Care Unit (SICU). Patients who initiated EN within 3 days were classified into the early EN group, while those who started EN between 3 and 7 days were classified into the delayed EN group. Propensity score matching was used to compare outcomes between the groups. Among 1,111 patients, 786 (70.7%) were in the early EN group and 325 (29.3%) were in the delayed EN group. Before propensity score matching, the early EN group demonstrated lower mortality (crude OR = 0.694; 95% CI: 0.514-0.936; p = 0.018) and shorter ICU stays (8.3 [5.2, 12.3] vs. 10.0 [7.5, 14.2] days; p < 0.001). After matching, no significant difference in mortality was observed. However, the early EN group had shorter ICU stays (8.3 [5.2, 12.4] vs. 10.1 [7.5, 14.2] days; p < 0.001) and a lower incidence of AKI stage 3 (49.3% vs. 55.5%; p = 0.030). Subgroup analysis revealed that early EN significantly reduced the 28-day mortality rate in sepsis patients with lactate levels ≤4 mmol/L, with an adjusted odds ratio (aOR) of 0.579 (95% CI: 0.361, 0.930; p = 0.024). Early enteral nutrition may not significantly reduce overall mortality in sepsis patients but may shorten ICU stays and decrease the incidence of AKI stage 3. Further research is needed to identify specific patient characteristics that benefit most from early EN.

Safety and outcome of early enteral nutrition in patients receiving extracorporeal membrane oxygenation

To explore the benefits and risks of early enteral nutrition (EN) in patients receiving extracorporeal membrane oxygenation (ECMO). A single center retrospective review was performed including patients receiving ECMO for more than 24h from May 2014 to July 2021. A total of sixty-five patients were enrolled, of which thirty-six patients (55.4%) received early EN. On ECMO day 3rd, 7th and 14th, the median energy intake through EN in the early EN group was 500kcal (IQR:300, 880), 1000kcal (IQR: 500, 1500) and 1000kcal (500, 1500), representing 29.7%, 66.7% and 66.7% of energy target, respectively. Thirteen (36.1%) patients had EN intolerance in the early EN group, which is significantly lower than that in the delayed EN group (82.8%, P<0.001). The most common reasons for EN intolerance were abdominal distention (22.2%), followed by elevated gastric residual volume (8.3%) in the early EN group. Forty-three (66.1%) patients successfully weaned off ECMO, with higher rate in the early EN group than in the delayed EN group (80.6% vs 48.3%, p=0.006). Nineteen patients (52.8%) survived in the early EN group, which is also significantly higher than that in the delayed EN group (20.7%, P=0.008). Patients receiving early enteral nutrition significantly reduced the mortality rate and the adjusted mortality hazard ratio was 0.22 (95%CI:0.10, 0.47). Early EN was safe and well-tolerated and can reduce the in-hospital mortality of patients receiving ECMO. For patients receiving ECMO, EN started with hypocaloric doses within 48h of ECMO initiation is recommend.

Clinical effect of early enteral nutrition support on critically ill neonates with extracorporeal membrane oxygenation

ObjectiveTo investigate the feasibility and clinical outcomes of early enteral nutrition (EN) in critically ill neonates supported by extracorporeal membrane oxygenation (ECMO).MethodsWe retrospectively analyzed the clinical data of 16 critically ill neonates who received ECMO support for respiratory and circulatory failure from July 2021 to December 2022 at our center. The patients were divided into two groups: the early EN group (< 24 h) and the late EN group (> 24 h). The related clinical and nutrition-related indicators between the groups were compared.ResultsThere was a significant difference in the time from ECMO treatment to the start of EN between the early EN group (9 patients, 56.2%) and the late EN group (7 patients, 43.8%) (P < 0.05). However, there were no significant differences in ECMO duration, hospitalization time, vasoactive-inotropic score (VIS), intestinal oxygen saturation, or routine stool occult blood (OB) test between the two groups (all P > 0.05). The incidence of complications such as intestinal obstruction, abdominal distension, diarrhea, and necrotizing enterocolitis (NEC) was slightly lower in the early EN group, but the differences were not statistically significant (all P > 0.05). The early EN group had a shorter time [3.6 (3.5, 5) vs. 7.5 (5.9, 8.5) d] to reach full gastrointestinal nutrition compared to the late EN group (P < 0.05).ConclusionProviding early nutritional support through enteral feeding to critically ill neonates receiving ECMO treatment is both safe and practical, but close monitoring of clinical and nutritional indicators is essential.

Using Machine-Learning to Assess the Prognostic Value of Early Enteral Feeding Intolerance in Critically Ill Patients: A Retrospective Study.

The association between gastrointestinal intolerance during early enteral nutrition (EN) and adverse clinical outcomes in critically ill patients is controversial. We aimed to assess the prognostic value of enteral feeding intolerance (EFI) markers during early ICU stays and to predict early EN failure using a machine learning (ML) approach. We performed a retrospective analysis of data from adult patients admitted to Beilinson Hospital ICU between January 2011 and December 2018 for more than 48 h and received EN. Clinical data, including demographics, severity scores, EFI markers, and medications, along with 72 h after admission, were analyzed by ML algorithms. Prediction performance was assessed by the area under the receiver operating characteristics (AUCROC) of a ten-fold cross-validation set. The datasets comprised 1584 patients. The means of the cross-validation AUCROCs for 90-day mortality and early EN failure were 0.73 (95% CI 0.71-0.75) and 0.71 (95% CI 0.67-0.74), respectively. Gastric residual volume above 250 mL on the second day was an important component of both prediction models. ML underlined the EFI markers that predict poor 90-day outcomes and early EN failure and supports early recognition of at-risk patients. Results have to be confirmed in further prospective and external validation studies.

Percutaneous Endoscopic Gastrostomy Placement in Trauma Patients: Early vs Delayed Initiation of Enteral Feeding.

In critically ill trauma patients, adequate nutrition is essential for the body's healing process. Currently, there is no clinical standard for initiating feeds after percutaneous endoscopic gastrostomy (PEG) tube placement. We aimed to demonstrate that early enteral nutrition (EN) is as safe as delayed EN in patients who have undergone PEG tube insertion. We conducted a multi-center, retrospective cohort study of 384 patients from the Prisma Health Trauma Registries who received PEGs. Feeding intolerance was defined as high gastric residuals, nausea, emesis, sustained diarrhea, or ileus. The probability that a patient would experience intolerance was 11.7% in those fed within 6hours, 5.1% among patients fed between 6 and 12hours, 6.0% among patients fed between 12 and 24hours, and 7.6% among patients fed after 24hours, for which no statistically significant difference was detected. These findings support that early EN after PEG placement is safe in critically ill, trauma patients.

Nutritional Support in Children Meeting the At-Risk for Pediatric Acute Respiratory Distress Syndrome Criteria.

To examine associations between early enteral nutrition (EN) and PICU outcomes in a cohort of children meeting the 2015 Pediatric Acute Lung Injury Consensus Conference "at-risk" for pediatric acute respiratory distress syndrome (ARF-PARDS) criteria. This was a single-center, electronic health record-based retrospective chart review. We included children less than or equal to 18 years-old admitted to our mixed medical-surgical PICU from January 2017 to December 2018 who met ARF-PARDS criteria within 48 hours of admission. Children were categorized as receiving "early" EN if feeds were initiated within 48 hours of admission. All others were categorized as "delayed" EN. Extracted data included demographics, illness characteristics including primary diagnosis and Pediatric Risk of Mortality (PRISM) III score, respiratory support and oxygenation indices, nutritional data, and PICU length of stay (LOS). The primary outcome of interest was subsequent diagnosis of PARDS. Of 201 included children, 152 (75.6%) received early EN. The most common admission diagnoses were pneumonia, bronchiolitis, and influenza. Overall, 21.4% (n = 43) of children developed PARDS. Children receiving early EN had a subsequent diagnosis of PARDS less often then children receiving delayed EN (15.1% vs 40.8%; p < 0.001), an association that persisted after adjusting for patient demographics and illness characteristics, including PRISM III and diagnosis (adjusted odds ratio, 0.24; 95% CI, 0.10-0.58; p = 0.002). Early EN was also associated with a shorter PICU LOS in univariate analysis (2.2 d [interquartile range, 1.5-3.4 d] vs 4.2 d [2.7-8.9 d]; p < 0.001). In this single-center, retrospective cohort study, compared with children with ARF-PARDS who received late EN, those who received early EN demonstrated a reduced odds of subsequent diagnosis of PARDS, and an unadjusted reduction in PICU LOS when compared with delayed EN. Prospective studies should be designed to confirm these findings.

Assessment of effects of intra-abdominal pressure monitoring on evaluating early enteral nutrition in patients with acute pancreatitis

To explore the role of intra-abdominal pressure (IAP) monitoring in evaluating the efficacy of early enteral nutrition (EN) in patients with acute pancreatitis (AP). The clinical data were collected from the AP patients in department of criticle care medicine of Baoshan Branch of Huashan Hospital Affiliated to Fudan University from July 2020 to June 2021. The patients were divided into three groups according to their treatments: no gastrointestinal decompression with fasting group, gastrointestinal decompression with fasting group, gastrointestinal decompression with indwelling jejunal tube within 24 hours group. The data of white blood cell (WBC), procalcitonin (PCT), serum amylase (AMY) and IAP were analyzed before and after treatment, the initiation time oral feeding were also analyzed. The decrease of WBC, PCT, AMY, and IAP in gastrointestinal decompression with indwelling jejunal tube within 24 hours group were significantly greater than those in the other groups [WBC (×109/L): -1.72±0.74 vs. -0.68±0.36, -1.23±86.97; PCT (μg/L): -3.14±5.19 vs. 0.06±0.48, -1.57±0.78; AMY (U): -148.43±75.89 vs. -74.85±78.84, -93.78±1.17; IAP (cmH2O, 1 cmH2O ≈ 0.098 kPa): -4.82±1.66 vs. 0.36±1.32, -3.22±4.36, all P < 0.05]. There were no correlation between the changes of IAP and the changes of WBC, PCT or AMY in the non-gastrointestinal decompression with fasting group and the gastrointestinal decompression with indwelling jejunal tube within 24 hours group (all P > 0.05). The decreasing trend of IAP in patients with gastrointestinal decompression with fasting group was positively correlated with the change of AMY (r = 0.65, P < 0.001). The initiation time of oral feeding in gastrointestinal decompression with indwelling jejunal tube within 24 hours group was significantly shorter than that in the other groups (hours: 89.538 vs. 111.273, 109.714), the difference was statistically significant (P < 0.05). IAP monitoring, as an emergency means of monitoring the efficacy of early EN in AP patients, has the advantages of simplicity, efficiency and rationality, which has a more objective basis than the previous empirical treatment and open oral feeding.

Early Enteral Nutrition Can Reduce Incidence of Postoperative Hydrocephalus in Patients with Severe Hypertensive Intracerebral Hemorrhage.

BackgroundHydrocephalus secondary to hypertensive intracerebral hemorrhage (HICH) dramatically affects the prognosis. Early enteral nutrition (EN) is beneficial to severe HICH patients, but the impact of early EN administration on hydrocephalus remains unknown. This study aimed to explore the predictors for hydrocephalus occurrence after HICH, with special focus on the effect of early EN application.Material/MethodsWe retrospectively analyzed 146 patients with severe HICH who underwent microsurgery between January 2014 and October 2019 in our department. Patients were divided into early EN (≤48 h) and delayed EN (>48 h) group according to the time-point of EN administration. The diagnosis of hydrocephalus was confirmed by both radiological evaluation and an Evan index method. Diagnosis confirmed within 2 weeks after HICH was identified as acute hydrocephalus, otherwise, it was considered as chronic hydrocephalus.ResultsTwenty-seven patients experienced acute hydrocephalus, while 20 patients developed chronic hydrocephalus. Low preoperative Glasgow coma scale (GCS), subarachnoid hemorrhage (SAH), intraventricular hemorrhage (IVH), delayed EN administration, high levels of postoperative white blood cell, neutrophil, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), and lactate dehydrogenase were positively related to the occurrence of chronic hydrocephalus (p<0.05), while only IVH was correlated with acute hydrocephalus occurrence (p<0.05). In addition, a multivariate analysis demonstrated that preoperative GCS, SAH, IVH, and early EN administration (p<0.05) were independent predictors for chronic hydrocephalus occurrence.ConclusionsEarly EN administration, SAH, IVH, and preoperative GCS were associated with the occurrence of chronic hydrocephalus in severe HICH patients. Early EN administration may inhibit the inflammatory response of brain-gut axis, which in turn reduces chronic hydrocephalus occurrence.

Nutrition during extracorporeal life support: A review of pathophysiological bases and application of guidelines.

Patients on extracorporeal life support (ECLS), either for respiratory or cardiac support, are at high risk of malnutrition; guidelines on nutrition in critical care have not incorporated solid evidence regarding these settings. The aim of this narrative review is to gather the available evidence in the existing literature and transpose general principles to the ECLS population. A literature review of observational and interventional studies on nutrition during ECLS, and evaluation of nutrition guidelines in this perspective. Nutrition is paramount for improving outcomes in ECLS, as well as in critically ill patients. The caloric needs during ECLS can vary according to the severity of the clinical state, sedation, paralysis, and temperature stability. Precise evaluation of energy expenditure by indirect calorimetry is difficult because ECLS is a system dedicated to removing carbon dioxide; however, modified equations composed of carbon dioxide values taken from the membrane lung are available. Guidelines suggest starting early enteral nutrition (EN) with a hypocaloric (70%-80% of the needs) strategy, also in acute states such as septic or cardiogenic shock. Moreover, EN, despite previous concerns, is feasible in prone position, an increasingly adopted strategy during mechanical ventilation. The catabolic state is maximal in these patients, causing a protein and muscular reduction. Therefore, adequate protein delivery should be guaranteed by administering a high protein intake of up to 2g/kg/day. Studies on nutrition tailored to ECLS patients are warranted. Early hypocaloric EN with high protein intake, tailored on indirect calorimetry, may be the most appropriate option.

Postoperative oral energy and protein intakes for an enhanced recovery after surgery program incorporating early enteral nutrition for pancreaticoduodenectomy: A retrospective study.

Although postoperative early oral feeding in the enhanced recovery after surgery (ERAS) program for pancreaticoduodenectomy (PD) is deemed safe, the assessment of oral intakes has been insufficient. This study aimed to investigate postoperative oral intakes and the effectiveness of an ERAS program incorporating early enteral nutrition (EN). In total, 203 patients with PD were enrolled retrospectively. The first group (group E1; n = 61) comprised 11 ERAS care elements, whereas the second group (group E2; n = 106) comprised 19 elements. The control group (group C; n = 36) was managed using traditional care before ERAS was implemented. Postoperative energy and protein requirements were estimated at 25-30 kcal per kilogram of ideal body weight and 1.2-1.5 g per kilogram of ideal body weight, respectively, and were investigated along with the length of hospital stay (LOS). The oral energy and protein intakes from the diets in the ERAS groups at postoperative day 7 significantly increased compared with those in group C. Intakes in groups E1 and E2 were not significantly different and provided <30% of the requirements. However, the total intakes, which were compensated by EN, were maintained at >80% of the requirements. LOS was significantly shorter in groups E1 (31 days) and E2 (19 days) than in group C (52 days). Postoperative early oral energy and protein intakes of this modified ERAS program failed to meet the dietary requirements. However, early EN compensated for the shortages and contributed to the reduction of LOS.

Energy Achievement Rate Is an Independent Factor Associated with Intensive Care Unit Mortality in High-Nutritional-Risk Patients with Acute Respiratory Distress Syndrome Requiring Prolonged Prone Positioning Therapy.

Early enteral nutrition (EN) and a nutrition target >60% are recommended for patients in the intensive care unit (ICU), even for those with acute respiratory distress syndrome (ARDS). Prolonged prone positioning (PP) therapy (>48 h) is the rescue therapy of ARDS, but it may worsen the feeding status because it requires the heavy sedation and total paralysis of patients. Our previous studies demonstrated that energy achievement rate (EAR) >65% was a good prognostic factor in ICU. However, its impact on the mortality of patients with ARDS requiring prolonged PP therapy remains unclear. We retrospectively analyzed 79 patients with high nutritional risk (modified nutrition risk in the critically ill; mNUTRIC score ≥5); and identified factors associated with ICU mortality by using a Cox regression model. Through univariate analysis, mNUTRIC score, comorbid with malignancy, actual energy intake, and EAR (%) were associated with ICU mortality. By multivariate analysis, EAR (%) was a strong predictive factor of ICU mortality (HR: 0.19, 95% CI: 0.07–0.56). EAR >65% was associated with lower 14-day, 28-day, and ICU mortality after adjustment for confounding factors. We suggest early EN and increase EAR >65% may benefit patients with ARDS who required prolonged PP therapy.

Early enteral nutrition and factors related to in-hospital mortality in people on extracorporeal membrane oxygenation

ObjectivesThere are concerns about adverse events related to early enteral nutrition (EN) in people receiving extracorporeal membrane oxygenation (ECMO). This was a retrospective study evaluating. This nutritional support of people receiving ECMO, factors that may confer benefits in outcomes. Methods60 adults on ECMO who survived for more than 48 h were enrolled in the study. We evaluated energy and protein intake and the associations of the timing, adequacy, and route of nutrition with in-hospital mortality. ResultsThirty-three participants (55%) were successfully weaned off ECMO, and 30 (50%) survived. EN was initiated on day 2 of ECMO (interquartile range, 1–3), and the mean energy intake on day 7 of ECMO was 94.1% ± 41.8% of the energy requirement. Although early EN significantly decreased in-hospital mortality (hazard ratio, 0.413; 95% confidence interval, 0.174–0.984; P = 0.046), neither adequate energy intake (hazard ratio, 0.982; 95% confidence interval, 0.292–3.301; P = 0.977) nor EN-dominant nutritional support (hazard ratio, 0.394; 95% confidence interval, 0.138–1.128; P = 0.083) in the first week influenced survival. ConclusionsAlthough adequate nutritional support and EN-dominant nutritional support were not associated with changes in outcome, early EN was associated with reduced in-hospital mortality. Therefore, even when EN is not the dominant route of nutritional support, early EN may be recommended for better outcomes in people on ECMO.

Enteral nutrition in circulatory shock: friend or foe?

Circulatory shock is associated with reduced splanchnic blood flow and impaired gut epithelial barrier function (EBF). Early enteral nutrition (EN) has been shown in animal models to preserve EBF. There are limited human data informing early EN in circulatory shock and critical care nutrition guidelines provide disparate recommendations regarding the optimal timing and dose. The purpose of this review is to describe the harms and benefits of early EN in circulatory shock by identifying and appraising recent human data. The cumulative risk of nonocclusive bowel ischemia and necrosis in patients with circulatory shock is no higher than 0.3% across observational and randomized controlled trial-level data, and whether the risk is increased by EN delivery remains uncertain. Observational data suggest that early EN in circulatory shock is associated with improved clinical outcomes but data from robust randomized controlled trials remain equivocal, so the optimal timing and dose remain unknown. Based on the best available data, initiating restrictive dose EN into the stomach after initial resuscitation in patients with circulatory shock does not appear to be harmful. In fact, early EN may preserve EBF and improve clinical outcomes.

Possible clinical outcomes using early enteral nutrition in individuals with allogeneic hematopoietic stem cell transplantation: A single-center retrospective study.

Intensive nutritional support during allogeneic hematopoietic stem cell transplantation (allo-HSCT) yields improved clinical outcomes. However, the clinical implications of early enteral nutrition (EN) in allo-HSCT remain unclear. This retrospective study was conducted to determine the significance of early EN in individuals who underwent allo-HSCT, and the association between early nutritional intervention and clinical outcomes, including the status of the intestinal microbiome. Thirty-one participants received EN before conditioning. The intestinal microbiota was examined by meta 16S rRNA gene sequencing of fecal samples. The median body mass variation was only -0.35 kg on day 60. The probability of 2-y overall survival was 61.1%. The cumulative incidence of treatment-related mortality was 17.4%, and those of acute graft-versus-host disease were 32.3% (grades II-IV) and 3.2% (grades III-IV). Chronic graft-versus-host disease was observed in four participants. Dysbiosis of the intestines and acute graft-versus-host disease occurred simultaneously, and Enterococcus species were abundant. Our results suggest that early nutritional support can improve the outcomes for individuals who have undergone allo-HSCT and can maintain homeostasis of their intestinal microbiome. Future prospective clinical trials are required to elucidate the role of EN in allo-HSCT and the association between the intestinal microbiome and EN.

Early Enteral Nutrition Preserves Intestinal Barrier Function through Reducing the Formation of Neutrophil Extracellular Traps (NETs) in Critically Ill Surgical Patients.

Background The gut was suggested as the driver of critical illness and organ injury. Recently, excessive formation of neutrophil extracellular traps (NETs) was associated with mucosal inflammation. Direct investigation of intestinal mucosa is essential to illuminate the potential mechanism of gut barrier in critically ill patients. We hypothesized that early enteral nutrition (EN) could decrease intestinal NETs and maintain the gut barrier. Methods Intestinal biopsies were obtained using biopsy forceps from critically ill surgical patients complicated with enterocutaneous fistula. Expressions of tight junction (TJ) proteins, mucosal inflammation, and apoptosis were evaluated. Moreover, NET-associated proteins were evaluated in intestinal specimens of patients by Western blot and immunofluorescence analysis. Results The intestinal barrier was significantly impaired in critically ill patients receiving early total parenteral nutrition (TPN), evidenced by intestinal villi atrophy, inflammatory infiltration, increased enterocyte apoptosis, and abnormal TJ expressions. Early EN significantly alleviated these intestinal injuries. In addition, we observed increased formation of the NET structure and elevated expressions of NET-associated proteins in intestines of critically ill surgical patients. Early EN was associated with the diminished presence of NETs and reduced expression of NET-associated proteins. Mechanically, analysis of the TLR4 pathway showed a significant increase in TLR4, NFκB, and MAPK signaling in patients receiving TPN when compared to those receiving early EN. Conclusion The intestinal barrier is disrupted in the human gut during critical illness. Our data suggests that an increased NET structure was showed in the gut of critically ill surgical patients, and early EN treatment was associated with the reduction of NET formation and the preservation of mucosal immunity.

Open abdomen treatment for complicated intra-abdominal infection patients with gastrointestinal fistula can reduce the mortality.

To evaluate the effect of the open abdomen (OA) and closed abdomen (CA) approaches for treating intestinal fistula with complicated intra-abdominal infection (IFWCIAI), and analyze the risk factors in OA treatment.IFWCIAI is associated with high mortality rates and healthcare costs, as well as longer postoperative hospital stay. However, OA treatment has also been linked with increased mortality and development of secondary intestinal fistula.A total of 195 IFWCIAI patients who were operated over a period of 7 years at our hospital were retrospectively analyzed. These patients were divided into the OA group (n = 112) and CA group (n = 83) accordingly, and the mortality rates, hospital costs, and hospital stay duration of both groups were compared. In addition, the risk factors in OA treatment were also analyzed.OA resulted in significantly lower mortality rates (9.8% vs 30.1%, P < .001) and hospital costs ($11721.40 ± $9368.86 vs $20365.36 ± $21789.06, P < .001) compared with the CA group. No incidences of secondary intestinal fistula was recorded and the duration of hospital stay was similar for both groups (P = .151). Delayed OA was an independent risk factor of death following OA treatment (hazard ratio [HR] = 1.316; 95% confidence interval [CI] = 1.068–1.623, P = .010), whereas early enteral nutrition (EN) exceeding 666.67 mL was a protective factor (HR = 0.996; 95% CI = 0.993–0.999, P = .018). In addition, Acinetobacter baumannii, Pseudomonas aeruginosa, and Candida albicans were the main pathogens responsible for the death of patients after OA treatment.OA decreased mortality rates and hospital costs of IFWCIAI patients, and did not lead to any secondary fistulas. Early OA and EN also reduced mortality rates.

Effect of early enteral nutrition in elderly patients with hip fracture during the perioperative period.

This study aimed to assess the effects of early enteral nutrition (EN) in elderly patients with hip fracture. The patients were classified into two groups (with and without EN). We compared the pre- and postoperative albumin (ALB) and inflammatory marker levels of each group and the time spent in bed and quality of life 3 months after surgery between the two groups. The pre- and postoperative IL-6 levels of the experimental group (61.68 ± 51.80 pg/L) were lower than those of the control group (233.11 ± 206.31 pg/L) (P< 0.001). The experimental group spent a shorter period of time in bed (38.75 ± 14.26 days) in comparison to the control group (99.71 ± 56.87 days) (P< 0.001). Quality of life was better in the experimental group than in the control group (P< 0.001). Early EN reduced the increment of postoperative IL-6 levels and improved healing postoperatively.

Analysis of clinical effects of early enteral nutrition standardized treatment process management on patients with acute exacerbation of chronic obstructive pulmonary disease on invasive mechanical ventilation

To investigate the effect of early enteral nutrition (EN) standardized treatment process management on the ventilation treatment effect and prognosis of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) on invasive mechanical ventilation. Forty-three patients with AECOPD on invasive mechanical ventilation admitted to Shenzhen Baoan District People's Hospital from January 2017 to December 2018 were enrolled. According to the start time of the continuous quality improvement project of nutritional support treatment for critically ill patients in the hospital, 20 patients from January 1st to December 31st in 2017 were enrolled in the routine EN group, and 23 patients from January 1st to December 31st in 2018 were enrolled in the early EN group. In the early EN group, when the patient was hemodynamically stable within 24 hours after intensive care unit (ICU) admission and there was no contraindication for EN, early trans nasal intestinal EN was started, and the infusion rate was adjusted or parenteral nutrition was added according to the EN tolerance score. The target feeding amount was 104.6-125.5 kJ×kg-1×d-1, and achieve complete EN. The conventional EN group started EN after patients had experienced the early stress stage, the vital signs were stable, and 48 hours after ICU admission. The management process was the same as the early EN group. The ventilation indicators including rapid shallow breathing index (RSBI), arterial blood pH value, arterial oxygen partial pressure (PaO2), arterial partial pressure of carbon dioxide (PaCO2), and base excess (BE) at weaning, PaCO2, CO2 retention rate at 2 hours after weaning, as well as critical management indicators including the incidence of ventilator-associated pneumonia (VAP), duration of invasive mechanical ventilation, length of ICU stay, total hospitalization cost and re-intubation rate between the two groups were compared. After the early EN standardized treatment process management, the RSBI at weaning of the patients in the early EN group was significantly lower than that in the conventional EN group (times×min-1×L-1: 36.68±16.12 vs. 52.63±14.81, P < 0.05), but no significant difference in pH value, PaO2, PaCO2 or BE was found as compared with the conventional EN group. The PaCO2 and CO2 retention rate at 2 hours after weaning in the early EN group were significantly lower than those in the conventional EN group [PaCO2 (mmHg, 1 mmHg = 0.133 kPa): 52.48±7.62 vs. 58.32±8.43, CO2 retention rate: (10.25±2.86)% vs. (18.46±3.21)%, both P < 0.05]. Compared with the conventional EN group, the incidence of VAP [8.7% (2/23) vs. 15.0% (3/20)], duration of invasive mechanical ventilation (hours: 52.64±14.81 vs. 53.78±12.75), length of ICU stay (days: 4.92±1.26 vs. 5.24±1.84), total hospitalization costs (thousand Yuan: 20.9±4.8 vs. 21.0±6.9) and re-intubation rate [13.0% (3/23) vs. 20.0% (4/20)] were slightly decreased in the early EN group without statistically significance (all P > 0.05). The management of early EN standardized treatment process for patients with AECOPD on invasive mechanical ventilation may alleviate the respiratory muscle fatigue status, and does not increase the complications.

230 Factors Affecting Gastric Intolerance to Enteral Nutrition in Burn Patients

Early enteral nutrition (EN) provides many benefits including attenuating stress hormones and the hypermetabolic response, decreasing gut permeability, and reducing the energy and protein deficit. Timing of EN is crucial as studies have shown that delaying initiation of EN leads to intolerance of enteral feeding. Burn size has also been correlated with timing and intolerance of EN with larger burns having delayed feeding times and more gastric intolerance. The aim of this study is three-fold: to determine if there is an association between 1) burn size and gastric intolerance; 2) inhalation injury and gastric intolerance; 3) delayed initiation of enteral feeding and gastric intolerance. A retrospective study was conducted on one hundred twenty eight patients admitted to our burn center who required EN from August 2013 to June 2018. Gastric intolerance was defined by four factors: emesis, gastric residual volume >500ml, distention, and the therapeutic use of prokinetic agents. Delayed enteral feeding was defined as ≥12 hours post-admission to the hospital. Patients were grouped by presence of inhalation injury and percentage of total body surface area (<20% and ≥20% TBSA). Using SPSS, Chi Square and multiple regression analyses were performed. The average burn size was 30%. Mean time to start EN was 16.8 hours and patients had an average of 3.2 episodes of intolerance throughout their hospitalization. %TBSA and the presence of an inhalation injury were associated with intolerance. Patients with ≥20%TBSA had one or more signs of gastric intolerance (p = 0.003). Presence of an inhalation injury was associated with two or more episodes of gastric intolerance (p = 0.043). Delayed initiation of EN was also associated with two or more episodes of gastric intolerance (p = 0.017). Adequate nutrition is vital for the burn patient. Larger burn size (≥20%TBSA) and inhalation injury are associated with greater gastric intolerance. Early EN (<12hrs post-admit) is associated with less gastric intolerance which allows patients to receive a greater percentage of their necessary nutrition for healing. In patients with a burn size ≥20%TBSA and/or the presence of an inhalation injury, post-pyloric access could be considered along with early initiation of EN to reduce gastric intolerance and failure to meet the patient’s nutrition goals. <!--EndFragment-->

Efficacy of prebiotics and probiotics in early enteral nutrition for the recovery of gastrointestinal function of pancreas trauma

Objective To study the influence of prebiotics and probiotics combined with early enteral nutrition (EN) on the recovery of gastrointestinal function, improvement of nutritional status and prognosis in postoperative patients with pancreatic trauma. Methods A retrospective analysis of the clinical data of pancreatic injury patients admitted to our hospital from January 2012 to December 2017 was carried out, and those patients were divided into 3 groups: group A (control group), patients treated with operation and routine treatment; group B, patients treated with prebiotics and probiotics in addition to surgery and routine treatment; group C, patients treated as group B in addition to early EN. Comparisons of blood biochemical markers, mortality, time required for resolution of abdominal pain, length of hospital stay, hospitalization expenses and complication rate among three groups. Results The time required for resolution of abdominal pain, length of hospital stay, hospital costs in group C were significantly lower than those in other groups (P < 0.05). The score of gastrointestinal dysfunction at one week after surgery in group C was significantly lower than that in group A and group B (P<0.05). Serum amylase, lipase and CRP levels were significantly lower in group C than those in other groups (P < 0.05). Plasma albumin level significantly higher in group C than that in other groups (P < 0.05). Conclusion Prebiotics and probiotics combined with early EN treatment have certain advantages in patients with pancreatic injury. Key words: Prebiotics; Probiotics; Early enteral nutrition; Pancreatitis trauma; Gastrointestinal function; Influence