Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure.

Rice TW, Mogan S, Hays MA, Bernard GR, Jensen GL, Wheeler AP
Crit Care Med. 2011 39 (5): 967-74

PMID: 21242788 · PMCID: PMC3102124 · DOI:10.1097/CCM.0b013e31820a905a

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.

MeSH Terms (23)

Academic Medical Centers Acute Disease Adult Aged Critical Care Enteral Nutrition Female Follow-Up Studies Hospital Mortality Humans Intensive Care Units Kaplan-Meier Estimate Male Middle Aged Nutritional Requirements Parenteral Nutrition Respiration, Artificial Respiratory Insufficiency Risk Factors Statistics, Nonparametric Survival Rate Time Factors Treatment Outcome

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