Abstract
BACKGROUND: Critically ill patients may be unconscious or unable to receive oral nutritional support and, hence are at increased risk of malnutrition. This study aimed to evaluate the effect of early moderate enteral nutrition on morbidity among patients admitted with shock as compared to conventional nutritional strategies. OBJECTIVE: The objective was to study the effect of early moderate enteral nutrition on the duration of ICU and hospital length of stay. MATERIALS AND METHODS: 120 patients admitted to the medical ICU with shock, were randomized into early enteral feed (study) and conventional feed (control) groups. Baseline parameters, hemodynamic SOFA score, and serum lactate values were recorded at admission. All patients (n = 60) in the study group were started on enteral nutritional support with isoosmotic, isocaloric (15 kcal/kg/day), standard recommended protein and polymeric preparation within 24 hours of admission until ICU discharge/ initiation of oral feeding or death. In the conventional nutritional strategy group (n = 60), hypocaloric (10 kcal/kg/day) feed was administered enterally after the vasopressor requirement was <0.1 mcg/kg/min or until the patient was hemodynamically stable. Patients were regularly fed after 48 hours of endotracheal intubation. RESULTS: The ICU length of stay (days, mean Standard deviation) was longer in the control group (10.17, 6.51) as compared to the study group (7.17, 5.36) which was found to be statistically significant [Wilcoxon-Mann-Whitney U Test (W) = 1116.000, p = <0.001]. The hospital length of stay (days, mean Standard deviation) was significantly shorter (W = 1294.000, p = 0.008) in the study group (10.13, 6.38) compared to the control group (13.48, 7.99). DISCUSSION: In this single-center randomized study, we were able to establish that early initiation of isocaloric moderate intensity feeds was feasible and was associated with lesser mortality, quicker reversal of shock, and lesser number of days on ventilator. These advantages translate into an overall shorter duration of stay in the ICU as well as in the hospital. This strategy should therefore be attempted among all ventilated patients in shock. Withholding feeds in anticipation of shock reversal could prolong the LOS in the hospital. This study did not show a survival benefit in the conventional group but was not powered to detect this outcome. CONCLUSIONS: Early moderate enteral nutrition in ventilated patients with shock may be associated with a shorter ICU and hospital length of stay compared to conventional nutritional strategies.