Acute lung injury patients on ventilators who require a feeding tube have a similar number of ventilator-free hospital days and similar mortality rates when receiving a low-calorie feeding program initially followed by a full-calorie program as when receiving a full-calorie program immediately, according to a new clinical study.
The patients in the low-calorie, or delayed, feeding program received about 400 calories per day for the first six days before advancing to a full feeding program. The patients enrolled in the full feeding program were advanced as quickly as they could tolerate to a full daily calorie and protein goal based on weight (averaging about 1,300 calories per day).
"The appropriate feeding protocol for mechanically ventilated patients is an important practical question that has been debated in ICUs for decades," said Susan B. Shurin, MD, acting director of the National Heart, Lung and Blood Institute, which funded the study and is part of the National Institutes of Health.
"Nutrition is important for healing, but feeding may lead to bowel complications in acutely ill patients. This study suggests that in cases of acute lung injury, physicians can take into account the patient's tolerance to feeding in reaching caloric goals."
Previous clinical studies that enrolled small numbers of patients have produced conflicting results on the amount of feeding to provide ventilated patients. Some studies indicate that full feeding as soon as possible can improve patient health and their outcomes. Other findings have suggested that starting out with lower calories could improve patient recovery by reducing gastrointestinal problems such as vomiting or constipation.
This new study enrolled 1,000 mechanically ventilated adult patients with acute lung injury who required a feeding tube. The primary clinical outcomes measured were the number of days alive and off the ventilator each patient had in the first 28 days, as well as overall mortality after 60 days.
Patients on the delayed feeding program had an average of 14.9 ventilator-free days and 23.2% mortality. Patients on the full feeding program had an average of 15 ventilator-free days and 22.2% mortality. The researchers noted that patients in the full feeding group showed slightly higher rates of vomiting and constipation, although this was a secondary outcome of the study.
The researchers said that because these findings were in adult patients ventilated for acute lung injury from largely medical causes, such as pneumonia or sepsis, extrapolation to surgical patients or children must be done cautiously.
The study was presented Sunday at the Society of Critical Care Medicine Congress in Houston and appears on the website of JAMA. To read it, visit http://bit.ly/AekAj7.
The patients in the low-calorie, or delayed, feeding program received about 400 calories per day for the first six days before advancing to a full feeding program. The patients enrolled in the full feeding program were advanced as quickly as they could tolerate to a full daily calorie and protein goal based on weight (averaging about 1,300 calories per day).
"The appropriate feeding protocol for mechanically ventilated patients is an important practical question that has been debated in ICUs for decades," said Susan B. Shurin, MD, acting director of the National Heart, Lung and Blood Institute, which funded the study and is part of the National Institutes of Health.
"Nutrition is important for healing, but feeding may lead to bowel complications in acutely ill patients. This study suggests that in cases of acute lung injury, physicians can take into account the patient's tolerance to feeding in reaching caloric goals."
Previous clinical studies that enrolled small numbers of patients have produced conflicting results on the amount of feeding to provide ventilated patients. Some studies indicate that full feeding as soon as possible can improve patient health and their outcomes. Other findings have suggested that starting out with lower calories could improve patient recovery by reducing gastrointestinal problems such as vomiting or constipation.
This new study enrolled 1,000 mechanically ventilated adult patients with acute lung injury who required a feeding tube. The primary clinical outcomes measured were the number of days alive and off the ventilator each patient had in the first 28 days, as well as overall mortality after 60 days.
Patients on the delayed feeding program had an average of 14.9 ventilator-free days and 23.2% mortality. Patients on the full feeding program had an average of 15 ventilator-free days and 22.2% mortality. The researchers noted that patients in the full feeding group showed slightly higher rates of vomiting and constipation, although this was a secondary outcome of the study.
The researchers said that because these findings were in adult patients ventilated for acute lung injury from largely medical causes, such as pneumonia or sepsis, extrapolation to surgical patients or children must be done cautiously.
The study was presented Sunday at the Society of Critical Care Medicine Congress in Houston and appears on the website of JAMA. To read it, visit http://bit.ly/AekAj7.
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