Improved enteral feeding for first seven days linked to lower 28-day mortality in critically sick patients

Recently published study aimed to assess the association between nutrition intake and 28-day mortality in critically ill patients receiving exclusive enteral nutrition (EN) during the first week of ICU admission and the potential impact of lactate levels on this association. The study was a post hoc analysis of a cluster-randomized clinical trial and included 1322 patients who received exclusive EN during their first week of ICU stay. The findings showed that increased energy and protein delivery during the first week were associated with a significant reduction in 28-day mortality. However, this association was observed only in patients with lactate concentration ≤ 2 mmol/L and not in those with lactate concentration > 2 mmol/L. The study also highlighted that the nutrition therapy provided was suboptimal, with most patients receiving only approximately 50% of their energy and protein requirements.

Findings and Association with Mortality

The study addressed the potential impact of using ideal body weight instead of actual body weight and found that the results remained stable in different models. The authors acknowledged limitations of the study, such as the post hoc nature, differences in patient populations, and the inability to weigh the importance of energy and protein delivery due to multicollinearity. The study concluded that enhanced nutrition delivery was associated with reduced 28-day mortality in critically ill patients receiving exclusive EN during the first week of ICU admission, particularly in patients with lactate concentration ≤ 2 mmol/L. The findings suggest that further prospective studies are needed to confirm these results and address the limitations identified in this study.

Reference

Chen, Y., Liu, Z., Wang, Q. et al. Enhanced exclusive enteral nutrition delivery during the first 7 days is associated with decreased 28-day mortality in critically ill patients with normal lactate level: a post hoc analysis of a multicenter randomized trial. Crit Care 28, 26 (2024). https://doi.org/10.1186/s13054-024-04813-6.