Rapid advancement of enteral nutrition and in-hospital mortality in critically ill adults: A retrospective cohort study

IF 3.2 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition Pub Date : 2024-10-04 DOI:10.1002/jpen.2691

Jungwon Cho PhD, Ahreum Shin MSc, Chami Im MD

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Abstract

Background

Early enteral nutrition (EN) initiation is recommended for intensive care unit (ICU) patients; however, the optimal rate of EN advancement remains unclear. We aimed to assess the association between EN advancement and in-hospital mortality, as well as length of hospital stay.

Methods

We performed a retrospective cohort study on 341 critically ill adults receiving EN between January 2021 and December 2023. The exposure of interest was rapid EN advancement, defined as an EN change exceeding the median value calculated between the first and seventh days after EN initiation. The comparator group included patients without rapid EN advancement. Factors related to in-hospital mortality and length of hospital stay were assessed using multivariable logistic and linear regression analyses. Subgroup analyses were performed for EN initiation within 48 h of ICU admission.

Results

Rapid EN advancement reduced in-hospital mortality (adjusted odds ratio [OR] = 0.64, 95% CI 0.38–1.07, P = 0.092), although this was not statistically significant. However, rapid EN advancement significantly shortened hospital stay by 25 days (95% CI −25 to −9.2, P = 0.002). In the early EN initiation subgroup, rapid EN advancement significantly reduced in-hospital mortality (adjusted OR = 0.42, P = 0.039) and shortened hospital stay by 48 days (95% CI −77 to −19, P = 0.001).

Conclusion

Rapid EN advancement reduced in-hospital mortality and length of hospital stay in critically ill patients, especially with early EN initiation. These findings could inform clinical practices that enhance timely and adequate nutrition therapy in ICUs. Further randomized controlled trials can help establish clinical guidelines.

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快速推进肠内营养与重症成人院内死亡率：一项回顾性队列研究。

背景：建议重症监护病房（ICU）患者尽早开始肠内营养（EN）；然而，EN的最佳推进速度仍不明确。我们旨在评估肠内营养推进与院内死亡率和住院时间之间的关系：我们对 2021 年 1 月至 2023 年 12 月期间接受 EN 的 341 名成人重症患者进行了一项回顾性队列研究。研究关注的风险暴露是EN快速进展，即EN变化超过EN启动后第1天到第7天之间计算的中位值。对比组包括未发生快速EN进展的患者。采用多变量逻辑和线性回归分析评估了与院内死亡率和住院时间相关的因素。对在入住重症监护室48小时内启动EN的患者进行了分组分析：快速推进EN可降低院内死亡率（调整赔率比[OR] = 0.64，95% CI 0.38-1.07，P = 0.092），但无统计学意义。然而，快速EN可显著缩短住院时间25天（95% CI -25至-9.2，P = 0.002）。在早期EN启动亚组中，快速EN推进可显著降低院内死亡率（调整后OR = 0.42，P = 0.039），缩短住院时间48天（95% CI -77至-19，P = 0.001）：快速推进EN可降低重症患者的院内死亡率并缩短住院时间，尤其是在早期启动EN的情况下。这些发现可为临床实践提供参考，从而加强重症监护病房及时、充分的营养治疗。进一步的随机对照试验有助于制定临床指南。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Parenteral and Enteral Nutrition 医学-营养学

CiteScore

7.80

自引率

8.80%

发文量

161

审稿时长

6-12 weeks

期刊介绍： The Journal of Parenteral and Enteral Nutrition (JPEN) is the premier scientific journal of nutrition and metabolic support. It publishes original peer-reviewed studies that define the cutting edge of basic and clinical research in the field. It explores the science of optimizing the care of patients receiving enteral or IV therapies. Also included: reviews, techniques, brief reports, case reports, and abstracts.