title: Early enteral nutrition and outcomes of critically ill patients treated with vasopressors and mechanical ventilation.
abstract: OBJECTIVE
  To determine the effect of early enteral feeding on the outcome of critically ill medical patients whose hemodynamic condition is unstable.
  
  
  METHODS
  Prospectively collected data in a multi-institutional medical intensive care unit database were analyzed retrospectively. A total of 1174 patients were identified who required mechanical ventilation for more than 2 days and were treated with vasopressor agents to support blood pressure. The patients were divided into 2 groups: those who received enteral nutrition (n = 707) within 48 hours of the start of mechanical ventilation, termed the early enteral nutrition group, and those who did not (n = 467), termed the late enteral nutrition group. The primary end points were overall intensive care unit and hospital mortality. Subgroup analyses were used to evaluate potential confounding variables. The data were also analyzed after adjustments for confounding by matching for propensity score.
  
  
  RESULTS
  Intensive care unit and hospital mortality were lower in the early enteral nutrition group than in the late enteral group: 22.5% vs 28.3%; P = 03; and 34.0% vs 44.0%; P < .001, respectively. The beneficial effect of early feeding was more evident in the sickest patients, that is, those treated with multiple vasopressors (odds ratio, 0.36; 95% confidence interval, 0.15-0.85) and those without early improvement (odds ratio, 0.59; 95% confidence interval, 0.39-0.90). When adjustments were made for confounding by matching for propensity score, early feeding was associated with decreased hospital mortality.
  
  
  CONCLUSIONS
  Early enteral nutrition may be associated with reduced intensive care unit and hospital mortality in patients whose hemodynamic condition is unstable.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, John D. Dingell VA Medical Center, Detroit, Michigan, USA.
authors.forename: Imran
authors.initials: I
authors.lastname: Khalid
authors.forename: Pratik
authors.initials: P
authors.lastname: Doshi
authors.forename: Bruno
authors.initials: B
authors.lastname: DiGiovine
mesh_terms: D015331:Cohort Studies; D003422:Critical Care / Q000379:methods*; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012121:Respiration, Artificial / Q000379:methods*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*
chemical_list: D014662:Vasoconstrictor Agents