EDEN Trial

JAMA

February 29, 2012

Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury.

What was the research question?

  • Does initial lower volume trophic enteral feeding within 48 hours increase ventilator-free days and decrease gastrointestinal intolerance compared to full enteral feeding in ARDS patients requiring mechanical ventilation?


How did they do it?

  • A multicenter, open label, randomized, controlled trial at 44 hospitals in the Ardent.

  • 1000 adults with acute lung injury (PaO2:FiO2 <300) within 48 hours and ventilated for less than 72 hours were randomized to trophic enteral feeding versus full enteral feeding for the first 6 days.

  • Trophic enteral feeding goal was 20kCal/hour compared to 25-30 kg/kg/day in the full enteral feeding group.


What did they find?

  • The trophic group received less enteral calories for the first 6 days, about 400 kcal/d compared with 1300 kcal/d (P < .001).

  • Ventilator-free days were not different between the two groups (14.9 vs 15; P = .89)

  • 60-day mortality was not statistically different (23.2% vs 22.2%; P = .77).

  • Organ-failure days, or ICU-free days were not statistically different between the two groups.

  • There were no differences in infectious complications between the groups.

  • Fewer gastrointestinal intolerance in the trophic feeding group (1.7% vs 2.2%; P = .05), elevated gastric residual volumes (2.2% vs 4.9%; P < .001), and constipation (2.1% vs 3.1%; P = .003) of feeding days.

  • Mean plasma glucose values and average hourly insulin requirement were both higher in the full-feeding group over the first 6 days.


Any limitations?

  • Possible bias in reporting gastrointestinal intolerances as it is an open-label trial.

  • Extensive exclusion list with 87% of screened patients were excluded.


What does it mean?

  • Trophic enteral feeding did not significantly affect ventilator-free days, 60-day mortality, or infectious complications compared to full enteral feeding in patients with ARDS and PaO2:FiO2 <300 within 6 days of injury but had less rate of gastrointestinal intolerance.

  • The practice in ICU is to start enteral tube feeding within the first 24 hours and increase to full calorie if tolerated; otherwise, use trophic enteral feeding.

EDEN Trial