Is early enteral nutrition a risk factor for gastric intolerance and pneumonia?
BACKGROUND
Early enteral nutrition (EN) after injury reduces septic complications, but upper digestive intolerance (UDI) occurring immediately post-trauma is a risk factor for pneumonia. Our study aimed to determine whether early intragastric feeding may lead to gastric intolerance and subsequent pneumonia in ventilated multiply injured patients.


METHODS
This prospective study involved two groups of patients randomized either to immediate intragastric EN, or to delayed intragastric EN started later than 24 h after admission. UDI was diagnosed when gastric residual volume, measured with a 50-ml syringe after stopping the feeding for 2 h, exceeded 200 ml at least at two consecutive measurements, and/or when vomiting occurred.


RESULTS
Out of 52 patients, 27 were included in the early EN group, and 25 in the delayed-EN group. On day 4, the early EN group received a greater amount of feeding because of intolerance problems occurring in the delayed-EN group (1175 +/- 485 ml vs. 803 +/- 545 ml). Twenty-five subjects--33% of the early EN patients and 64% of the delayed-EN patients--met the criteria for pneumonia (P = 0.050). On average, patients with pneumonia were older, more severely injured, and therefore required more ventilator days and a longer stay in the intensive care unit than patients without pneumonia.


CONCLUSIONS
If properly administered, early enteral nutrition can decrease the incidence of upper intestinal intolerance and nosocomial pneumonia in patients with multiple injuries.
Clinical Centre Ljubljana, University of Ljubljana, CIT, Zalos?ka cesta 7, 1000 Ljubljana, Slovenia. lidija.kompan@mf.uni-lj.si
Lidija
L
Kompan
Gaj
G
Vidmar
Alenka
A
Spindler-Vesel
J
J
Pecar
D000328:Adult; D000367:Age Factors; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D009104:Multiple Trauma / Q000628:therapy*; D011014:Pneumonia / Q000453:epidemiology* / Q000209:etiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D015599:Trauma Severity Indices