Early versus late enteral feeding in patients with acute cervical spinal cord injury: a pilot study.
METHODS
A prospective randomized clinical pilot study to compare early versus late enteral feeding in patients with acute cervical spinal cord injury.


OBJECTIVE
To compare the incidence of infections in patients with acute cervical spinal cord injury who received early versus late enteral feeding. Secondary objectives included assessing nutritional status, feeding tolerance, the number of ventilator hours, and acute-care hospital length of stay.


BACKGROUND
Early nutritional support has been found to be beneficial in critically ill patients. However, the same benefits may not be realized in patients with acute cervical spinal cord injury because of their unique nutritional challenges.


METHODS
Eligible patients were randomized to early feeding (initiated before 72 hours after injury) and late (initiated more than 120 hours after injury). Patients were stratified on the basis of their neurologic level. Patients were assessed daily for the first 15 days. After that time, infections (according to Center for Disease Control criteria), ventilator hours, and length of acute-care hospital stay were tracked.


RESULTS
Twenty-three patients met the eligibility criteria, and 17 patients were included in the analysis. There were 7 patients in the early group and 10 in the late group. The early group had a mean of 2.4 +/- 1.5 infections compared with the late group, which had a mean of 1.7 +/- 1.1 infections. Secondary outcomes were not substantially different between the two groups.


CONCLUSIONS
This pilot study failed to detect any differences in the incidence of infection, nutritional status, feeding complications, number of ventilator hours, or length of stay between patients receiving early versus late initiation of enteral feeding. These data will assist in the determination of an adequate sample size for future studies.
Dvorak
Marcel F
MF
Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada. mdvorak@vanhosp.bc.ca
Noonan
Vanessa K
VK
Bélanger
Lise
L
Bruun
Birthe
B
Wing
Peter C
PC
Boyd
Michael C
MC
Fisher
Charles
C
D000208:Acute Disease; D000328:Adult; D002574:Cervical Vertebrae / Q000293:injuries*; D003428:Cross Infection / Q000175:diagnosis / Q000209:etiology; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications / Q000151:congenital* / Q000534:rehabilitation*; D009752:Nutritional Status; D010865:Pilot Projects; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D013119:Spinal Cord Injuries / Q000534:rehabilitation*; D016896:Treatment Outcome