A retrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting.
OBJECTIVE
To determine whether early nutritional support reduces mortality and the incidence of nosocomial infection, in critically ill patients in the current practice.


METHODS
A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician's assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders.


RESULTS
Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant.


CONCLUSIONS
Our study shows that early nutrition support reduces ICU mortality in critically ill patients, although it does not demonstrate any influence over nosocomial infection in the current practice in intensive care.
Intensive Care Unit, Hospital General San Jorge, SALUD, Huesca, Spain. cseron@unizar.es
C
C
Serón-Arbeloa
J
J
Puzo-Foncillas
T
T
Garcés-Gimenez
J
J
Escós-Orta
L
L
Labarta-Monzón
A
A
Lander-Azcona
D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data*; D016638:Critical Illness / Q000401:mortality*; D003428:Cross Infection / Q000150:complications / Q000453:epidemiology*; D002149:Energy Intake; D019317:Evidence-Based Medicine; D005260:Female; D006769:Hospitals, General; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018529:Nutritional Support / Q000379:methods; D044343:Overnutrition / Q000150:complications; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D013997:Time Factors