Early hypocaloric enteral nutritional supplementation in acute organophosphate poisoning--a prospective randomized trial.
BACKGROUND
Early institution of enteral feeds may be associated with improved outcomes in the critically ill. This study evaluated the effect of hypocaloric enteral nutritional supplementation in acute organophosphate(OP)-poisoned patients requiring invasive mechanical ventilation.


METHODS
Prospective randomized controlled trial conducted in the medical intensive care unit (ICU) of a tertiary care university teaching hospital.


METHODS
During a 13-month period, 87 OP-poisoned patients were admitted. Twenty-seven patients who were not ventilated were excluded. Thirty patients were randomized to the control arm and 29 to the intervention arm. The intervention arm received hypocaloric nasogastric feeds within 48 h of intubation whilst the control arm received intravenous fluids. Primary outcome was infectious complications. Secondary outcomes included hospital mortality, duration of ventilation, ICU stay, and hospital stay.


RESULTS
An infectious complication occurred in 14 patients (48%) in the intervention group and 15 patients (50%) in the control group (p = 0.898). Three patients in each group died (p = 0.965). Duration of ventilation (p = 0.19) and ICU stay (p = 0.41) were similar. Duration of hospital stay was shorter in the control group (p = 0.05). Gastric stasis occurred in two patients (6.9%) receiving enteral feeds. Feeding related complications were less frequent than in other published trials.


CONCLUSIONS
In OP-poisoned patients, early hypocaloric enteral feeding was not associated with improvements in clinical endpoints, albeit longer hospital stay was observed in the enterally fed group. Feeding related complications were infrequent. Further studies would help define the status of early enteral feeding in this subset of patients.
Moses
Viju
V
Department of Medicine, Christian Medical College and Hospital, Vellore, TN, India. vijumoses@gmail.com
Mahendri
Narayani V
NV
John
George
G
Peter
John Victor
JV
Ganesh
Alka
A
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D016638:Critical Illness; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D018589:Gastroparesis / Q000453:epidemiology / Q000209:etiology; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007239:Infections / Q000453:epidemiology / Q000209:etiology; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D062025:Organophosphate Poisoning; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome; D055815:Young Adult