Late Enteral Nutrition Research Articles

Effects of Micro-Ecological Enteral Nutrition on Systemic Inflammatory Response, Bacterial Translocation, and Immune Function in Patients with Severe Acute Pancreatitis

We have evaluated the effect of early and late micro-ecological enteral nutrition on systemic inflammatory response, bacterial translocation, and immune function in patients with severe acute pancreatitis. Two weeks after treatment, experimental group receiving early nutritional intervention exhibited a significant increase in intestinal lactobacilli and bifidobacteria, fewer staphylococci, and E. coli, and lower levels of serum endotoxin, D-lactic acid, and diamine oxidase than the group receiving late intervention (control group) (P < 0.05). Also, the serum levels of CD3+ and CD4+ and CD4+/CD8+ ratio significantly increase after 2 weeks of intervention. On the other hand, the level of CD8+ and the Acute Physiology and Chronic Health Evaluation II and Modified Computed Tomography Severity Index scores significantly decreased after 2 weeks of treatment (P < 0.05). The early intervention also led to a significant shortening of time needed for abdominal pain relief, anal exhaustion, resumption of peristaltic sound, and hospitalization. Furthermore, there was a significant increase in overall response rate, and decrease in the incidence rate of complications (P < 0.05). Early micro-ecological enteral nutrition therapy can effectively relieve systemic inflammatory response, prevent intestinal bacterial translocation, restore the function of intestinal mucosal barrier, and alleviate nutritional imbalance in severe acute pancreatitis patients leading to improved immune function, mitigation of the disease, and reduced complications benefiting the recovery of patients.

Protein intake deficiency in critically ill children with respiratory insufficiency: A call to action?

Adequate energy-protein intake is associated with improved clinical outcomes in critically ill children. The aim of this study was to evaluate the time of enteral nutrition (EN) onset and the energy-protein intake in critically ill pediatric patients admitted with respiratory insufficiency. A single-center prospective cohort study, including children and adolescents, aged from 1 month to 14 years. All patients had been diagnosed with respiratory insufficiency and were exclusively enterally fed and had been admitted to a Pediatric Intensive Care Unit (PICU) of a public quaternary hospital in southeastern Brazil. Demographic, clinical, and nutritional therapy characteristics were recorded. Early EN (EEN) was considered when EN was initiated within the first 48h of PICU admission. Seventy-one patients were included in this study, 64.79% were male with a median age of 6 months (2; 13) and a median PICU length of stay of 13.00 days (6.75; 23.00). PICU mortality was 4.23% and 78.87% of patients were under mechanical ventilation within the first 48h of PICU admission with a median time of mechanical ventilation of 10 days (6.00; 16.50). The median energy adequacy was 74.97% (50.29; 93.94) and the median protein adequacy was 56.12% (40.72; 69.81). Only 7.25% of the patients achieved protein adequacy. Nutritional variables were compared between groups: EEN and late EN (LEN). EEN was utilized in 69.01% of patients who had increased energy (41.80 [34.07; 51.17] versus 23.60 [11.22; 35.17] kcal/kg/day; p<0.0001) and protein intake (0.94 [0.78, 1.16] versus 0.53 [0.30, 0.79] g/kg/day, p<0.0001) and better nutritional adequacies (p<0.0001). Patients who received EEN had increased energy-protein delivery and adequacies. However, protein inadequacy occurred throughout in all patients within this sample, regardless the onset of EN.

Early Enteral Nutrition in Patients Undergoing Sustained Neuromuscular Blockade: A Propensity-Matched Analysis Using a Nationwide Inpatient Database.

Whether enteral nutrition should be postponed in patients undergoing sustained treatment with neuromuscular blocking agents remains unclear. We evaluated the association between enteral nutrition initiated within 2 days of sustained neuromuscular blocking agent treatment and in-hospital mortality. Retrospective administrative database study from July 2010 to March 2016. More than 1,200 acute care hospitals covering approximately 90% of all tertiary-care emergency hospitals in Japan. Mechanically ventilated patients, who had undergone sustained treatment with neuromuscular blocking agents in an ICU, were retrospectively reviewed. We defined patients who received sustained treatment with neuromuscular blocking agents as those who received either rocuronium at greater than or equal to 250 mg/d or vecuronium at greater than or equal to 50 mg/d for at least 2 consecutive days. Enteral nutrition started within 2 days from the initiation of neuromuscular blocking agents (defined as early enteral nutrition). We identified 2,340 eligible patients during the 69-month study period. Of these, 378 patients (16%) had received early enteral nutrition. One-to-three propensity score matching created 374-1,122 pairs. The in-hospital mortality rate was significantly lower in the early than late enteral nutrition group (risk difference, -6.3%; 95% CI, -11.7% to -0.9%). There was no significant difference in the rate of hospital pneumonia between the two groups (risk difference, 2.8%; 95% CI, -2.7% to 8.3%). Length of hospital stay among survivors was significantly shorter in the early compared with the late enteral nutrition group (risk difference, -11.4 d; 95% CI, -19.1 to -3.7 d). There was no significant difference between the two groups in length of ICU stay or length of mechanical ventilation among survivors. According to this retrospective database study, early enteral nutrition may be associated with lower in-hospital mortality with no increase in-hospital pneumonia in patients undergoing sustained treatment with neuromuscular blocking agents.

The Prophylactic Effect of Proton Pump Inhibitors Combined with Enteral Nutrition for Preventing Gastrointestinal Hemorrhage after Cardiovascular Surgery in High-Risk Patients.

Gastrointestinal hemorrhage (GH) is one of the most serious complications after cardiovascular surgery. The aim of the study was to provide an optimal therapeutic strategy for preventing postoperative GH in high-risk patients. This retrospective case-control study included 188 adult patients at high risk of postoperative GH. These patients were divided into two groups based on a strategy for preventing postoperative GH: Group A (n = 97) received continuous intravenous infusion of proton-pump inhibitor (PPI) combined with early enteral nutrition, and Group B (n = 91) received a bolus intravenous infusion of PPI combined with late enteral nutrition. The clinical features of the groups were examined. The incidence of postoperative GH in the patients of group A was significantly lower than the patients in group B. The duration from the end of surgery to eating for the first time in the patients of group A was significantly shorter than in the patients of group B. A descending trend in 30-day mortality was observed in the patients of group A compared with group B, but no significant difference was found between the two groups. Continuous intravenous infusion of PPI combined with early enteral nutrition could effectively prevent GH and reduce 30-day mortality after cardiovascular surgery in high-risk patients.

Differences in effect of early enteral nutrition on mortality among ventilated adults with shock requiring low-, medium-, and high-dose noradrenaline: A propensity-matched analysis

Despite extensive research on early enteral nutrition (EEN), it remains unclear whether EEN is effective for patients with shock requiring vasopressors. This study aimed to compare outcomes between EEN and late enteral nutrition (LEN) in ventilated patients with shock requiring low-, medium-, or high-dose noradrenaline. Using a national inpatient database in Japan, we identified ventilated patients admitted to intensive care units who had shock requiring catecholamines (noradrenaline or dobutamine) from July 2010 to March 2016. We defined patients who started enteral nutrition within 2 days after starting mechanical ventilation as EEN group and the others as LEN group. Propensity score matching was performedbetween patients undergoing EEN and LEN in each of the low- (<0.1μg/kg/min), medium- (0.1-0.3μg/kg/min), and high-dose (≥0.3μg/kg/min) noradrenaline groups. We identified 52,563 eligible patients during the 69-month study period, including 38,488, 11,042, and 3033 patients in the low-, medium-, and high-dose noradrenaline groups, respectively. One-to-two propensity score matching created 5,969, 2,162, and 477 one-to-two matched pairs in thelow-, medium-, and high-dose noradrenaline groups, respectively. The 28-day mortality rate was significantly lower in the EEN than LEN group in the low-dose noradrenaline group (risk difference,-2.9%; 95% confidence interval [CI],-4.5% to-1.3%) and in the medium-dose noradrenaline group (risk difference,-6.8%; 95% CI,-9.6% to-4.0%). In the high-dose noradrenaline group, 28-day mortality did not differ significantly between the EEN and LEN groups (absolute risk difference,-1.4%; 95% CI,-7.4%-4.7%). Although the size of the subgroup requiring high-dose noradrenaline may have been too small to demonstrate a significant difference, the results suggest that EEN was associated with a reduction in mortality in ventilated adults treated with low- or medium-dose noradrenaline but not in those requiring high-dose noradrenaline.

Enteral nutrition provided within 48 hours after admission in severe acute pancreatitis: A systematic review and meta-analysis.

Whether to conduct enteral nutrition in patients with severe acute pancreatitis (SAP) during the active phase of intestinal stress or to feed during remission remains controversial. This study was aimed to evaluate the efficacy and safety of enteral nutrition within 48 hours after admission in the patients with SAP or predicted severe acute pancreatitis (pSAP). We searched PubMed, EMBASE, Web of Science, and the Cochrane Library before December 2017. Randomized controlled trials of early enteral nutrition (starting within 48 hours after admission) versus late enteral nutrition or total parental nutrition in severe acute pancreatitis or predicted severe acute pancreatitis were selected. Ten randomized controlled trials containing 1051 patients were included. Comparing early enteral nutrition to late enteral nutrition or total parental nutrition in SAP or pSAP, the pooled risk ratios were 0.53 (95% confidence interval [CI] 0.35-0.81, P = .003) for mortality, 0.58 (95% CI 0.43-0.77, P = .0002) for multiple organ failure (MOF), 0.50 (95% CI 0.33-0.75, P = .0008) for operative intervention, 0.75 (95% CI 0.61-0.93, P = .009) for systemic infection, 0.42 (95% CI 0.26-0.69, P = .0005) for local septic complications, 0.84 (95% CI 0.74-0.96, P = .01) for gastrointestinal symptoms. 0.87 (95% CI 0.74-1.02, P = .08) for systemic inflammatory response syndrome (SIRS), and 1.24 (95% CI 0.66-2.31, P = .50) for other local complications. Enteral nutrition within 48 hours after admission is efficient and safe for the patients with SAP or pSAP.

Effect of enteral nutrition time on pH value of gastric juice and ventilator-associated pneumonia in critically ill patient

To investigate the effect of enteral nutrition (EN) start time on pH value of gastric juice and ventilator-associated pneumonia (VAP) in critically ill patients with invasive mechanical ventilation, so as to provide reference for the rational selection of EN timing. Patients with mechanical ventilation who underwent EN treatment admitted to the intensive care unit (ICU) of the First Affiliated Hospital of Zhengzhou University from January 1st, 2016 to November 30th, 2017 were enrolled, and the inclusion criteria were age ≥ 18 years, acute physiology and chronic health evaluation II (APACHE II) ≤ 15, and nutritional risk screening (NRS 2002) ≥ 3. Patients were divided into two groups according to the start time of EN: early EN group (implementation of EN within 48 hours after mechanical ventilation) and late EN group (implementation of EN after 48 hours after mechanical ventilation). The pH value of gastric juice, VAP incidence, mechanical ventilation time, and the length of ICU stay were compared between the two groups. A total of 108 patients were included, 54 in the early EN group and 54 in the late EN group respectively. The pH value of gastric juice in early EN group was lower than that in late EN group [4.8 (3.8, 5.8) vs. 5.6 (4.6, 6.6), P < 0.01]. There were 8 patients with VAP in the early EN group, 3 of whom were early onset VAP. There were 17 patients with VAP in the late EN group, 10 of whom were early onset VAP. The incidence of VAP and the incidence of premature VAP in the early EN group were significantly lower than those in the late EN group (14.8% vs. 31.5%, 5.6% vs. 18.5%, both P < 0.05). The mechanical ventilation time [days: 7.5 (5.7, 9.0) vs. 8.6 (6.8, 10.7) and the length of ICU stay [days: 10.0 (8.5, 11.7) vs. 11.0 (9.5, 12.6)] in the early EN group were significantly shorter than those in the late EN group (all P < 0.05). At the same time of protecting gastric mucosa, early EN is helpful to reduce the incidence of VAP, reduce the duration of mechanical ventilation and the length of ICU stay, and improve the prognosis.

Influence of enteral nutrition initiation timing on curative effect and prognosis of acute respiratory distress syndrome patients with mechanical ventilation

To explore the effect of enteral nutrition (EN) initiation time on the treatment and prognosis of acute respiratory distress syndrome (ARDS) patients with mechanical ventilation. A retrospective study was conducted. 116 adult ARDS patients with mechanical ventilation admitted to the intensive care unit (ICU) of the Sixth Division Hospital of Xinjiang from January 2016 to December 2017 were enrolled. There was no difference in gender, age, acute physiology and chronic health evaluation II (APACHE II) at admission. Patients were divided into early enteral nutrition group (E-EN group, 66 cases, starting EN within 48 hours) and late enteral nutrition group (L-EN group, 50 cases, starting EN after 7 days later) according to the EN initiation time. Both groups of patients achieved the standard nutrition after 3-5 days of EN. Nutritional indicators [albumin (ALB), pre-albumin (PA)], liver function [total bilirubin (TBIL)], infection index [procalcitonin (PCT)], insulin dosage, respiratory mechanics and pulmonary function [airway peak pressure (PIP), airway plateau pressure (Pplat), mean airway pressure (MPaw), effective static total compliance (Cst), oxygenation index (PaO2/FiO2)], critical scores [APACHE II, multiple organ dysfunction score (MODS), Murray lung injury score, and systemic inflammatory response syndrome (SIRS) score], duration of mechanical ventilation, the length of ICU stay, incidence of multiple organ dysfunction syndrome, 14-day mortality, and ICU hospitalization expenses were collected before treatment and 1, 3, 7, 10, 14 days after treatment. There was no difference in biochemical indicators, respiratory mechanics, pulmonary function, or critical scores between the two groups before ICU treatment. Compared with before treatment, ALB and PA were significantly increased, TBIL and MPaw were significantly decreased, insulin dosage was significantly decreased, PIP, Pplat, MPaw were significantly decreased, Cst and PaO2/FiO2 were significantly increased, and the critical scores were significantly decreased. Compared with L-EN group, E-EN group had lower TBIL and PCT after treatment [TBIL (μmol/L): 13.21±1.03 vs. 29.02±1.38, PCT (ng/L): 5.36±1.58 vs. 11.33±1.95], lower insulin dose (U: 16.37±1.01 vs. 27.01±1.92), lower PIP, Pplat, MPaw [PIP (cmH2O, 1 cmH2O = 0.098 kPa): 17.7±3.5 vs. 22.5±4.3, Pplat (cmH2O): 10.5±1.4 vs. 15.6±1.2, MPaw (cmH2O): 5.5±0.7 vs. 8.2±0.8], higher Cst, PaO2/FiO2 [Cst (mL/cmH2O): 128.6±16.5 vs. 93.7±11.9, PaO2/FiO2 (mmHg, 1 mmHg = 0.133 kPa): 242.9±27.9 vs. 188.6±25.9, all P < 0.05], however, there was no significant difference in ALB, PA and critical care scores [ALB (g/L): 37.09±1.49 vs. 35.88±1.77, PA (mg/L): 387.29±10.93 vs. 369.27±11.44, APACHE II: 13.9±3.5 vs. 14.5±5.0, Murray: 5.6±0.9 vs. 5.2±1.4, MODS: 1.1±0.4 vs. 1.2±0.3, SIRS: 2.9±0.5 vs. 3.1±0.9, all P > 0.05]. Compared with L-EN group, incidence of multiple organ dysfunction syndrome was significantly decreased in E-EN group [31.8% (21/66) vs. 48.0% (24/50), P < 0.05], duration of mechanical ventilation and the length of ICU stay were significantly shortened (days: 5.5±0.7 vs. 9.2±0.8, 8.6±1.5 vs. 18.3±1.9, both P < 0.05), ICU hospitalization expenses was significantly reduced (10 000 yuan: 6.324±0.009 vs. 11.419±0.010, P < 0.05), but there was no significantly difference in 14-day mortality between two groups [15.2% (10/66) vs. 16.0% (8/50), P > 0.05]. Early and reasonable application of EN supportive therapy can improve the clinical efficacy of ARDS patients, reduce the incidence of infection, make it easier to control blood sugar, improve lung function, shorten the duration of mechanical ventilation and the length of ICU stay, and reduce hospitalization expenses. However, no significant difference has been found in the prognosis of the recent 14 days.

The impact of early enteral nutrition on pediatric patients undergoing gastrointestinal anastomosis a propensity score matching analysis.

This study was conducted to assess the clinical advantages of early enteral nutrition (EEN) in pediatric patients who underwent surgery with gastrointestinal (GI) anastomosis.EEN has been associated with clinical benefits in various aspect of surgical intervention, including GI function recovery and postoperative complications reduction. Evaluable data documenting clinical advantages with EEN for pediatric patients after surgery with GI anastomosis are limited.We retrospectively reviewed the medical records of 575 pediatric patients undergoing surgical intervention with GI anastomosis. Among them, 278 cases were managed with EEN and the remaining cases were set as late enteral nutrition (LEN) group. Propensity score (PS) matching was conducted to adjust biases in patient selection. Enteral feeding related complications were evaluated with symptoms, including serum electrolyte abnormalities, abdominal distention, abdominal cramps, and diarrhea. Clinical outcomes, including GI function recovery, postoperative complications, length of hospital stay, and postoperative follow-up, were assessed according to EEN or LEN.Following PS matching, the baseline variables of the 2 groups were more comparable. There were no differences in the incidence of enteral feeding-related complications. EEN was associated with postoperative GI function recovery, including time to first defecation (3.1 ± 1.4 days for EEN vs 3.8 ± 1.0 days for LEN, risk ratio [RR], 0.62; 95% confidence interval [CI] 0.43–1.08, P = .042). A lower total episodes of complication, including infectious complications and major complications were noted in patients with EEN than in patients with LEN (117 [45.9%] vs 137 [53.7%]; OR, 0.73, 95% CI 0.52–1.03, P = .046). Mean postoperative length of stay in the EEN group was 7.4 ± 1.8 days versus 9.2 ± 1.4 days in the LEN group (P = .007). Furthermore, the incidence of adhesive small bowel obstruction was lower for patients with laxative administration compared with control, but no significant difference was attained (P = .092)EEN was safe and associated with clinical benefits, including shorten hospital stay, and reduced overall postoperative complications on pediatric patients undergoing GI anastomosis.

Early Versus Late Enteral Nutrition Following Upper Gastrointestinal Surgery – A Prospective Study

Early Versus Late Enteral Nutrition Following Upper Gastrointestinal Surgery – A Prospective Study

Meta-Analysis of Early Enteral Nutrition Provided Within 24 Hours of Admission on Clinical Outcomes in Acute Pancreatitis.

Enteral nutrition (EN) is more beneficial than parenteral nutrition (PN) in reducing organ failure, infectious complications, and mortality of acute pancreatitis (AP), but its timing is controversial. We attempted to evaluate the safety and clinical outcomes of early EN within 24 hours of admission in patients with AP, especially in predicted severe or severe acute pancreatitis (SAP). We searched PubMed, EMBASE Databases, Web of Science, and the Cochrane Library for relevant articles before June 2016 using RevMan 5.2 software. Eight studies containing 727 patients with AP were analyzed in the meta-analysis. Comparing early EN to late EN or total parental nutrition in AP, the odds ratios (OR) were 0.56 (95% CI 0.23 -1.34) for the risk of mortality, 0.40 (95% CI 0.20-0.79) for multiple organ failure, 0.57 (95% CI 0.23-1.42) for infectious complications, 0.45 (95% CI 0.17-1.21) for adverse events, and 0.83 (95% CI 0.59-1.18) for pancreatic-related infections. Furthermore, subgroup analysis for early EN in predicted severe or SAP showed a significant reduction in multiple organ failure (OR 0.30; 95% CI 0.09-0.96) and pancreatic-related infections (OR 0.51, 95% CI 0.29-0.88). Early EN provided no benefits for mild to moderate AP. Early EN within 24 hours of admission is safe and provides benefits for predicted severe or SAP, but not for mild to moderate pancreatitis.

The optimal timing of enteral nutrition and its effect on the prognosis of acute pancreatitis: A propensity score matched cohort study

BackgroundEarly enteral nutrition (EN) can improve the prognosis of acute pancreatitis (AP), but the optimal initiation time is unknown. In this study, the optimal time of early EN was analyzed to disclose the application of early EN in AP. MethodsData of 104 patients with AP were prospectively collected. With secondary infection (infected pancreatic necrosis and extrapancreatic infection) as the primary outcome variable, receiver operating characteristic (ROC) curve was used to calculate the optimal cut-off time of early EN. Propensity score matching was used to adjust for covariates. Secondary outcomes include acute gastrointestinal injury (AGI) grades, serum albumin level, and EN-related complications. ResultsThe ROC curve analysis showed that the third day after hospital admission was the best cut-off time of early EN (with the area under the curve of 0.744). After PS matching, the proportion of secondary infection in the early EN group was significantly lower than the late EN group (8.6% vs. 36.5%, P < 0.05). Regression analysis showed that early EN was a protective factor against secondary infection (OR 0.161, 95%CI 0.036–0.718, P < 0.05). The AGI grades and serum albumin levels were better improved in the early EN group (AGI F = 4.468, P < 0.05; serum albumin F = 3.794, P < 0.05).The proportion of EN-related abdominal distension in the early EN group was significantly lower (8.8% vs. 38.5%, P < 0.05). ConclusionsEarly EN initiated within three days could reduce the risk of secondary infection and improve the nutritional status of patients with acute pancreatitis, with a better tolerance.

Evaluation of the Safety of Early Compared to Late Enteral Nutrition in Canine Septic Peritonitis.

Septic peritonitis is a relatively common condition in the veterinary intensive care unit, with a classically high mortality rate. Early enteral nutrition (EEN) in critically ill humans can lead to improved outcome. This study was performed to determine the safety of early postoperative feeding in canine septic peritonitis. In this retrospective case series, 56 dogs were identified. Sixteen dogs received EEN, defined as nutrition within 24 hr of surgery; 27 received late enteral nutrition (LEN) defined as nutrition more than 24 hours following surgery; and 13 dogs had no enteral nutrition in hospital (NEN). Signalment, physical examination findings, and occurrence of pre-admission vomiting, regurgitation, and length of anorexia were the same amongst all groups. There was no significant difference in the number of gastrointestinal complications postoperatively between the EEN, LEN, and NEN groups or in the occurrence of vomiting/regurgitation postoperatively compared to preoperatively. There was no difference in the length of hospitalization between any group, although fewer dogs in the NEN group survived compared to the EEN/LEN combined group (46% [6/13] versus 81% [37/40]). This study indicates it is safe to initiate EEN without additional risk of gastrointestinal complications. Prospective studies are needed to evaluate the potential benefits of EEN in dogs with septic peritonitis.

WITHDRAWN: Early enteral nutrition versus late enteral nutrition for burns patients: A systematic review and meta-analysis

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Effects of early enteral nutrition on patients after emergency gastrointestinal surgery: a propensity score matching analysis.

Early postoperative enteral feeding has been demonstrated to improve the outcome of patients who underwent surgery for gastrointestinal (GI) malignancies, trauma, perforation, and/or obstruction. Thus, this study was conducted to assess the efficacy of early postoperative enteral nutrition (EN) after emergency surgery in patients with GI perforation or strangulation.The medical records of 484 patients, admitted between January 2007 and December 2012, were reviewed retrospectively. Patients were divided into 2 groups: the early EN (EEN, N = 77) group and the late EN (LEN, N = 407) group. The morbidity, mortality, length of hospital, and intensive care unit (ICU) stays were compared between the 2 groups. Propensity score matching was performed in order to adjust for any baseline differences.Patients receiving EEN had reduced in-hospital mortality rates (EEN 4.5% vs LEN 19.4%; P = 0.008), pulmonary complications (EEN 4.5% vs LEN 19.4%; P = 0.008), lengths of hospital stay (median: 14.0, interquartile range: 8.0–24.0 vs median: 17.0, interquartile range: 11.0–26.0, P = 0.048), and more 28-day ICU-free days (median: 27.0, interquartile range: 25.0–27.0 vs median: 25.0, interquartile range: 22.0–27.0, P = 0.042) than those receiving LEN in an analysis using propensity score matching. The significant difference in survival between the 2 groups was also shown in the Kaplan–Meier survival curve (P = 0.042). In a further analysis using the Cox proportional hazard ratio after matching on the propensity score, EEN was associated with reduced in-hospital mortality (hazard ratio, 0.03; 95% confidence interval, 0.01–0.49; P = 0.015).EEN is associated with beneficial effects, such as reduced in-hospital mortality rates, pulmonary complications, lengths of hospital stay, and more 28-day ICU-free days, after emergency GI surgery.

Effect of Early Enteral Nutrition on Clinical Outcomes in an Intensive Care Unit

unit. Objectives: The purpose of this study was to evaluate the effect of early enteral nutrition on clinical outcomes in medical patients admitted to the intensive care unit. Materials and Methods: This prospective study was performed on 94 patients admitted to the medical intensive care unit (ICU). The patients were divided into two groups according to nutrition onset. Enteral nutrition for group one was started within the first 48 hours of admission to the ICU and group two received enteral nutrition after the third day of admission to the ICU. Patients were monitored for ICU length of stay, organ failure (SOFA score), aspiration pneumonia, duration of mechanical ventilation and mortality. Results: The average daily caloric intake between the two groups did not differ significantly (P = 0.4). Both groups received more than 75% of the calculated required calorie. The mean duration of hospitalization, occurrences of organ failure and mortality were lower in patients who received their calculated daily nutrition during the first 48 hours of admission (P < 0.05). Regarding ventilator-associated pneumonia, there was no significant difference between the two groups of early and late enteral nutrition. There was no significant difference between the two groups of early and late nutrition in the duration of mechanical ventilation. Logistic regression analysis showed that late nutrition causes a 3.3 times increase in mortality rate, 1.3 times in the length of ICU stay and 1.8 times in organ failure (P < 0.05). Conclusions: Early enteral nutrition within 24 to 48 hours of admission to ICU reduces the duration of hospitalization, organ failure and mortality of the medical patients.

Impact of early versus late enteral nutrition on cell mediated immunity and its relationship with glucagon like peptide-1 in intensive care unit patients: a prospective study

IntroductionGlucagon-like peptide-1 (GLP-1) originates from the gastrointestinal system in response to the presence of nutrition in the intestinal lumen and potentiates postprandial insulin secretion. Also, it acts as an immune-modulator which has influences on cell-mediated immunity.The aim of this study was to determine the impact of early enteral nutrition versus late enteral nutrition on plasma GLP-1 levels and the relationship between GLP-1 changes and cell-mediated immunity.Materials and methodsThe study was designed as a prospective, single-blinded study and carried out in the neurology intensive care unit (ICU) of a university hospital. Twenty-four naive patients with acute thromboembolic cerebrovascular events, with National Institute of Health (NIH) stroke scores between 12 and 16, were included. Any condition interfering with GLP-1 and immunity was regarded as exclusion criterion. Two patients died, and two dropped out of the study due to complicating conditions.Patients were randomly subjected to early enteral feeding within the first 24 hours (Group 1), or late enteral feeding, beginning 48 hours after admission (Group 2) via a nasogastric tube. Calculated daily energy requirement was supplemented with parenteral nutrition, starting on the first study day for both groups. Blood samples were obtained before, and at 5, 15, 30, 60 and 120 minutes after the first enteral feeding for GLP-1 assays; this procedure was repeated on the third day. Before and 24 hours after the first enteral feeding, samples were also taken for immunological analysis. Clinical observations were recorded.Pre- and post-feeding plasma GLP-1 changes between the two groups and within groups were evaluated. Lymphocyte subgroup changes before and 24 hours after the first enteral feeding in relation to GLP-1 changes were sought as well.ResultsGroup 1 and Group 2 exhibited similar GLP-1 levels in the pre-feeding and post-feeding periods for both the first time and the third day of enteral feeding. Also, no significant change in pre-/post-feeding GLP-1 levels was observed within groups. T-helper and T-regulatory cells increased, T-cytotoxic cells decreased significantly in Group 1 (P = 0.02; P = 0.036; P = 0.0019), but remained the same in Group 2 after enteral feeding. Positive but statistically insignificant clinical effects in terms of predisposition to infections (10% vs 40%) and median time of ICU stay (10 vs 15 days) were observed in Group 1.ConclusionsDepending on our findings, we propose that early enteral feeding may cause amelioration in cell-mediated immunity via factors other than GLP-1 in ICU patients with acute thromboembolic stroke. However, the possible deleterious effects of parenteral nutrition cannot be ruled out.

Early Enteral Nutrition and Outcomes of Critically Ill Patients Treated With Vasopressors and Mechanical Ventilation

To determine the effect of early enteral feeding on the outcome of critically ill medical patients whose hemodynamic condition is unstable. Prospectively collected data in a multi-institutional medical intensive care unit database were analyzed retrospectively. A total of 1174 patients were identified who required mechanical ventilation for more than 2 days and were treated with vasopressor agents to support blood pressure. The patients were divided into 2 groups: those who received enteral nutrition (n = 707) within 48 hours of the start of mechanical ventilation, termed the early enteral nutrition group, and those who did not (n = 467), termed the late enteral nutrition group. The primary end points were overall intensive care unit and hospital mortality. Subgroup analyses were used to evaluate potential confounding variables. The data were also analyzed after adjustments for confounding by matching for propensity score. Intensive care unit and hospital mortality were lower in the early enteral nutrition group than in the late enteral group: 22.5% vs 28.3%; P = 03; and 34.0% vs 44.0%; P < .001, respectively. The beneficial effect of early feeding was more evident in the sickest patients, that is, those treated with multiple vasopressors (odds ratio, 0.36; 95% confidence interval, 0.15-0.85) and those without early improvement (odds ratio, 0.59; 95% confidence interval, 0.39-0.90). When adjustments were made for confounding by matching for propensity score, early feeding was associated with decreased hospital mortality. Early enteral nutrition may be associated with reduced intensive care unit and hospital mortality in patients whose hemodynamic condition is unstable.

Effect of early enteral nutrition on morbidity and mortality in children with burns

Burns increase the metabolic demands of the body and can lead to severe weight loss and increased risk of death. Early enteral support is believed to improve gastrointestinal, immunological, nutritional and metabolic responses to critical injury; however, this premise is in need of further substantiation by definitive data. This research aimed to examine the effectiveness and safety of early enteral feeding in paediatric patients suffering from burns. Materials and methods This clinical trial was carried out with a total number of 688 children with burns hospitalised in the Burn Department across a 2-year period (September 2002–September 2004). The subjects were randomised into two groups. A total of 322 patients received only intravenous resuscitation, in accordance with current treatment protocols, in the first 48 h and were considered as the late enteral nutrition group (LEN group); 366 patients were nourished early enteral nutrition group (EEN group), such that both groups received similar amounts of fluid in the first 48 h. Initiation of enteral nutrition commenced between 3 and 6 h following the burn. The patients were kept in the unit until they were discharged. Wound management did not vary between groups. Results In our study, the mean age was 5 ± 3 years in the LEN group and 5 ± 3.5 years in the EEN group. Hot liquids were the most common cause of burns in both groups. The mean percentage of burn was reported as 20 ± 13 in the LEN group and 22 ± 15 in the EEN group. Mean duration of hospitalisation was 16.4 ± 3.7 days in the LEN group and 12.6 ± 1.3 in the EEN group for cured patients ( P < 0.05). A total of 40 patients (12%) in the LEN group and 31 patients (8.5%) in the EEN group expired ( P < 0.05). Conclusion Our research showed that EEN decreases duration of hospitalisation and mortality in children with burns.

P019 NUTRITIONAL SUPPORT IN CRITICALLY ILL PATIENTS DECREASES THE LENGTH OF STAY AND THE MORTALITY RATE IN THE ICU

Rationale: Parenteral nutrition (PN) and enteral nutrition (EN) represent the nutritional support (NS) of critically ill patients (CP). However, the association between NS, with diagnosis (D), age (A), length of stay (LS), over the mortality rate (M) has not been established. Methods: In total, 305 CP with PN as the main NS were included. Four groups of NS were defined, 1) patients with early PN (in the first 48 hours in the ICU); 2) patients with late PN & EN; 3) patients with early PN & EN; 4) patients with late PN. Groups of D were defined; 1) acute severe pancreatitis; 2) metabolic disease without sepsis; 3) surgical without sepsis; 4) surgical with sepsis; 5) metabolic disease with sepsis; 6) trauma; 7) burned. Three groups of age were established, 18 40, 41 65 and 66 years old or more. The LS was divided in short; 10 days or less, medium; between 11 to 20 days and large; 21 days or more. Mortality or survival was observed. Chi-squared test and logistic regression models were used. Results: NS presented was: NS 1) for 36.4%; 2) 18.7%; 3) 37.7% and 4) 7.2%. The correlation between NS and D was: CP with NS 1&3 had D 3 & 4, in contrast CP with NS 2 & 4 had D 2 & 3, p < 0.001. The relation between NS and A was p = 0.70. An Association between NS and LS was founded: CP with NS 2 & 4 had large LS; compared with CP with NS 1 & 3 who had short LS, p < 0.001. The M was 23.9%. M was not associated with D, p = 0.24. But It was observed that M increases according with A and LS, p = 0.030 and p = 0.011, respectively. According with NS, the M presented was: CP with NS 1) 22.5%, NS 2) 19.3%, 3) 21.7%, 4) 54.5%. p = 0.006. The odd of mortality with a 95% confidence interval was: for CP with NS 3 odds ratio (OR) =0.129, p < 0.001, for CP with NS 2 OR= 0.19, p = 0.001 and for CP with NS 1 OR= 0.24, p = 0.006, compared with CP with NS 4. Conclusion: Early parenteral nutrition in addition with enteral nutrition decreases the LS in the ICU and reduces the M in critically ill patients of any age and diagnosis.