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.
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.