Saturday, June 10, 2006

Feeding in ventilated patients

Saturday June 10, 2006
Yes ! Feed Critically Ill Mechanically Ventilated Medical Patients early despite risk of VAP

There is some hesitancy in literature about early feeding for critically ill mechanically ventilated medical patients due to increase risk of ventilator-associated pneumonia (VAP)

Dr. Artinian and coll. from Division of Pulmonary and Critical Care Medicine, Henry Ford Health System, Detroit, MI recently looked into about 4000 patients requiring mechanical ventilation for more than 2 days
2. Those patients who received enteral feeding within 48 hours of mechanical ventilation were labeled as the "early feeding group" otherwise as "late feeding group." Results showed that

  • The overall ICU mortality was 18.1% vs 21.4%
  • The overall hospital mortality was 28.7% vs 33.5%

In substudy, three separate models were done using APACHE II, simplified acute physiology score II, and mortality prediction model at time 0. In all models, early enteral feeding was associated with

  • an approximately 20% decrease in ICU mortality
  • a 25% decrease in hospital mortality
  • The lower mortality rates in the early feeding group were most evident in the sickest group

The truth was found that in all adjusted analysis, early feeding was found to be independently associated with an increased risk of ventilator-associated pneumonia (VAP).

Study concluded that early feeding significantly reduces ICU and hospital mortality mainly in the sickest patients and should be instituted in medical patients receiving mechanical ventilation especially in patients at high risk of death, despite being associated with an increased risk of VAP developing.

Related previous pearls:
Where is my food dude !! and Is post pyloric feeding absolute ?

Reference: click to get abstract/article
Early versus late enteral feeding of mechanically ventilated patients: results of a clinical trial - Journal of Parenteral and Enteral Nutrition, Vol 26, Issue 3, 174-181
Effects of Early Enteral Feeding on the Outcome of Critically Ill Mechanically Ventilated Medical Patients - Chest. 2006;129:960-967