TITLE:
The Impact of Rate of Feeding Advancement after Early Initiation of Enteral Nutrition in Critically Ill, Underweight Patients: A Single-Center Retrospective Chart Review
AUTHORS:
Satomi Ichimaru, Maren Sono, Hidetoshi Fujiwara, Ryutaro Seo, Koichi Ariyoshi
KEYWORDS:
Critical Illness, Underweight, Mechanical Ventilation, Early Enteral Nutrition, Rate of Feeding Advancement
JOURNAL NAME:
Food and Nutrition Sciences,
Vol.7 No.11,
September
12,
2016
ABSTRACT: Background: The optimal rate of feeding advancement after initiation of early enteral
nutrition (EEN) for underweight, critically ill patients is unknown. Methods:
We conducted a retrospective chart review in intensive care unit (ICU) patients with
a body mass index (BMI) 2. Patients were categorized into Group R,
which reached the energy target within 3 days of EEN initiation, and Group S, which
reached the energy target 4 or more days after EEN initiation. Results: A total of 65
patients with a median age of 73 years were included in the study. No significant differences
were observed between the two groups for all-cause mortality, ICU-free
days, or length of hospital stay. Ventilator-free days (VFDs) were significantly fewer
in Group R than in Group S (18.0 [0.0 - 22.0] vs. 21.0 [16.3 - 24.8] days; P = 0.046).
A significantly higher number of patients requiring mechanical ventilation (MV) at
hospital discharge were observed in Group R than in Group S (29% vs. 8%; P =
0.030). Multivariable analyses with adjustment for confounders found that days required
to reach target energy intake after EEN initiation were significantly and independently
associated with the requirement for MV at hospital discharge, but not
with VFDs. Conclusion: A slow rate of feeding advancement after initiation of EEN
in critically ill patients having a BMI of 2 might be associated with a reduced
requirement for MV at hospital discharge. These results require confirmation
in a large multicenter trial of underweight, critically ill patients.