title: Early jejunal feeding initiation and clinical outcomes in patients with severe acute pancreatitis.
abstract: BACKGROUND
  Compared with parenteral nutrition, enteral nutrition reduces infectious complications and mortality in patients with severe acute pancreatitis (SAP). This study used clinical outcomes to investigate the association between time to initiation of distal jejunal feeding (DJF) and time to achievement of goal enteral feeding with clinical outcomes.
  
  
  METHODS
  A retrospective chart review was performed on all patients with SAP admitted to the medical intensive care unit (ICU) during a 1-year period. Collected data included demographic information, body mass index (BMI; kg/m(2)), Acute Physiology and Chronic Health Evaluation (APACHE) II scores at admission, time of onset of DJF, time to goal feeding, ICU length of stay, and mortality.
  
  
  RESULTS
  Time to starting DJF was longer in nonsurvivors (n = 4) than in survivors (n = 12) (17 vs 7 days, P < .05). All nonsurvivors had BMI >30 kg/m(2) (50% had BMI > 50 kg/m(2)). ICU length of stay was significantly associated with achievement of goal feeding. Three patients never reached goal feeding and spent 45.3 ± 19.6 days in the ICU; 7 patients reached goal feeding within 3 days of initiating DJF and spent 18 ± 1.7 days in the ICU; and 4 patients reached goal feeding within 3 days and spent 10.5 ± 3.5 days in the ICU. APACHE II scores were not significantly different among the 3 groups (16.7 ± 1.5, 12 ± 0.7, and 16.2 ± 1.2, respectively, P > .05).
  
  
  CONCLUSIONS
  Early initiation of DJF in the ICU was associated with reduced mortality in this cohort of patients with SAP. Early achievement of jejunal feeding goal early was associated with a shorter ICU length of stay, irrespective of the severity of SAP.
authors.affiliation: University of Pittsburgh, Pittsburgh, PA 15261, USA. Refaat.Hegazi@abbott.com
authors.forename: Refaat
authors.initials: R
authors.lastname: Hegazi
authors.forename: Amit
authors.initials: A
authors.lastname: Raina
authors.forename: Toby
authors.initials: T
authors.lastname: Graham
authors.forename: Susan
authors.initials: S
authors.lastname: Rolniak
authors.forename: Patty
authors.initials: P
authors.lastname: Centa
authors.forename: Hossam
authors.initials: H
authors.lastname: Kandil
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: O'Keefe
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007583:Jejunum / Q000601:surgery*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D010195:Pancreatitis / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult