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Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure
| Content Provider | Scilit |
|---|---|
| Author | Rice, Todd W. Mogan, Susan Hays, Margaret A. Bernard, Gordon R. Jensen, Gordon L. Wheeler, Arthur P. |
| Copyright Year | 2011 |
| Description | Journal: Critical Care Medicine |
| Abstract | Objective: Enteral nutrition is provided to mechanically ventilated patients who cannot eat normally, yet the amount of support needed is unknown. We conducted this randomized, open-label study to test the hypothesis that initial low-volume (i.e., trophic) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure. Design: Randomized, open-label study. Patients: A total of 200 patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hrs. Interventions: Patients were randomized to receive either initial trophic (10 mL/hr) or full-energy enteral nutrition for the initial 6 days of ventilation. Measurements and Main Results: The primary outcome measure was ventilator-free days to day 28. Baseline characteristics were similar between the 98 patients randomized to trophic and the 102 patients randomized to full-energy nutrition. At enrollment, patients had a mean Acute Physiology and Chronic Health Evaluation II score of 26.9 and a Pao2/Fio2 ratio of 182 and 38% were in shock. Both groups received similar durations of enteral nutrition (5.5 vs. 5.1 days; p = .51). The trophic group received an average of 15.8% ± 11% of goal calories daily through day 6 compared to 74.8% ± 38.5% (p < .001) for the full-energy group. Both groups had a median of 23.0 ventilator-free days (p = .90) and a median of 21.0 intensive-care-unit-free days (p = .64). Mortality to hospital discharge was 22.4% for the trophic group vs. 19.6% for the full-energy group (p = .62). In the first 6 days, the trophic group had trends for less diarrhea (19% vs. 24% of feeding days; p = .08) and significantly fewer episodes of elevated gastric residual volumes (2% vs. 8% of feeding days; p < .001). Conclusion: Initial trophic enteral nutrition resulted in clinical outcomes in mechanically ventilated patients with acute respiratory failure similar to those of early full-energy enteral nutrition but with fewer episodes of gastrointestinal intolerance. |
| Related Links | http://europepmc.org/articles/pmc3102124?pdf=render https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102124/pdf |
| Ending Page | 974 |
| Page Count | 8 |
| Starting Page | 967 |
| ISSN | 00903493 |
| e-ISSN | 15300293 |
| DOI | 10.1097/ccm.0b013e31820a905a |
| Journal | Critical Care Medicine |
| Issue Number | 5 |
| Volume Number | 39 |
| Language | English |
| Publisher | Ovid Technologies (Wolters Kluwer Health) |
| Publisher Date | 2011-05-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: Critical Care Medicine Nutrition and Dietetics Enteral Nutrition Acute Respiratory Failure Permissive Underfeeding |
| Content Type | Text |
| Resource Type | Article |
| Subject | Critical Care and Intensive Care Medicine |
