title: Early Trophic Enteral Nutrition Is Associated With Improved Outcomes in Mechanically Ventilated Patients With Septic Shock: A Retrospective Review.
abstract: OBJECTIVE
  Current guidelines provide weak recommendations for starting enteral nutrition (EN) in patients with septic shock (on vasopressor support). Outcomes of patients receiving EN in septic shock on vasopressor support have not been well studied. We hypothesize that early trophic EN in mechanically ventilated patients with septic shock is associated with improved outcomes.
  
  
  METHODS
  Single-center retrospective study of mechanically ventilated patients admitted with septic shock to identify patients receiving (1) no EN, (2) <600 kcal/d within 48 hours, and (3) ≥600 kcal/d within 48 hours. Outcomes studied included in-hospital mortality, length of intensive care unit stay (LOS), duration of mechanical ventilation (DOMV), and complications of feeding intolerance.
  
  
  RESULTS
  Sixty-six patients were identified. In all, 15 received no EN, 37 received <600 kcal/d, and 14 received ≥600 kcal/d EN daily. Median LOS was 12, 5, and 13 days, respectively. The LOS was lower in patients receiving <600 kcal/d when compared to either no EN (P < .001) or those receiving ≥600 kcal/d (P < .001). Median DOMV was lower in patients receiving <600 kcal/d (median 3, P < .001) as compared to no EN (median 7, P < .001) or those receiving ≥600 kcal/d (median 7.5, P < .001). Mortality was not different. There were no significant complications among groups.
  
  
  CONCLUSIONS
  In patients with septic shock, those receiving <600 kcal/d EN within 48 hours had lower DOMV and LOS when compared to those who did not receive EN or those who received ≥600 kcal/d. These observations provide strong justification for prospective evaluation of the effect of early trophic EN in patients with septic shock.
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA japatel@mcw.edu.
authors.forename: Jayshil J
authors.initials: JJ
authors.lastname: Patel
authors.affiliation: Department of Nutrition Services, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Kozeniecki
authors.affiliation: Department of Pharmacy Practice, Concordia University Wisconsin School of Pharmacy, Mequon, WI, USA.
authors.forename: Annie
authors.initials: A
authors.lastname: Biesboer
authors.affiliation: Department of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: William
authors.initials: W
authors.lastname: Peppard
authors.affiliation: Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Ananda S
authors.initials: AS
authors.lastname: Ray
authors.affiliation: Department of Pharmacy, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Seth
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Clement J. Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Jacobs
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Rahul
authors.initials: R
authors.lastname: Nanchal
authors.affiliation: Division of Pulmonary & Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI, USA Clement J. Zablocki VA Medical Center, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: Gagan
authors.initials: G
authors.lastname: Kumar
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care; D016638:Critical Illness / Q000628:therapy*; D002149:Energy Intake; D004750:Enteral Nutrition / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012772:Shock, Septic / Q000401:mortality / Q000628:therapy*; D016896:Treatment Outcome
keywords: enteral nutrition; mechanical ventilation; septic shock; trophic feeding