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. 2018 Mar;27(2):136-143.
doi: 10.4037/ajcc2018598.

Association Between Enteral Feeding, Weight Status, and Mortality in a Medical Intensive Care Unit

Michael T Vest  1 , Paul Kolm  2 , James Bowen  2 , Jillian Trabulsi  2 , Shannon L Lennon  2 , Mary Shapero  2 , Patty McGraw  2 , James Halbert  2 , Claudine Jurkovitz  2
Affiliations

Association Between Enteral Feeding, Weight Status, and Mortality in a Medical Intensive Care Unit

Michael T Vest et al. Am J Crit Care. 2018 Mar.

Abstract

Background: Clinical practice guidelines recommend enteral nutrition for most patients receiving mechanical ventilation. However, recently published evidence on the effect of enteral nutrition on mortality, particularly for patients who are well nourished, is conflicting.

Objectives: To examine the association between enteral feeding and hospital mortality in critically ill patients receiving mechanical ventilation and to determine if body mass index mediates this relationship.

Methods: A retrospective cohort study of patients receiving mechanical ventilation admitted to a medical intensive care unit in 2013. Demographic and clinical variables were collected. Cox proportional hazards regression was used to examine the relationship between an enteral feeding order and hospital mortality and to determine if the relationship was mediated by body mass index.

Results: Of 777 patients who had 811 hospitalizations requiring mechanical ventilation, 182 (23.4%) died in the hospital. A total of 478 patients (61.5%) received an order for enteral tube feeding, which was associated with a lower risk of death (hazard ratio, 0.41; 95% CI, 0.29-0.59). Body mass index did not mediate the relationship between mortality and receipt of an order for enteral feeding. Median stay in the unit was 3.6 days. Most deaths (72.0%) occurred more than 48 hours after admission.

Conclusion: The finding of a positive association between an order for enteral feeding and survival supports enteral feeding of patients in medical intensive care units. Furthermore, the beneficial effect of enteral feeding appears to apply to patients regardless of body mass index.

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Figures

Figure 1
Figure 1
Flow diagram shows reasons for exclusion from analytical data set. Abbreviations: Fio2, fraction of inspired oxygen; ICU, intensive care unit.
Figure 2
Figure 2
Survival curves for patients with an order for enteral nutrition versus no order for enteral nutrition.
Figure 3
Figure 3
Survival curves for patients with an order for enteral nutrition versus no order for enteral nutrition excluding patients who stayed in the intensive care unit for less than 24 hours.
See this image and copyright information in PMC

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