Impact of early nutrition and feeding route on outcomes of mechanically ventilated patients with shock: a post hoc marginal structural model study

Intensive Care Medicine
Jean ReignierOutcomeRea Network

Abstract

Few data are available about optimal nutrition modalities in mechanically ventilated patients with shock. Our objective was to assess associations linking early nutrition (<48 h after intubation), feeding route and calorie intake to mortality and risk of ventilator-associated pneumonia (VAP) in patients with invasive mechanical ventilation (IMV) and shock. In the prospective OutcomeRea database, we identified adults with IMV >72 h and shock (arterial systolic pressure <90 mmHg) within 48 h after intubation. A marginal structural Cox model was used to create a pseudo-population in which treatment was unconfounded by subject-specific characteristics. We included 3,032 patients. Early nutrition was associated with lower day-28 mortality [HR 0.89, 95 % confidence interval (CI) 0.81-0.98, P = 0.01] and day-7 mortality (HR 0.76, CI 0.66-0.87, P < 0.001) but not with lower day-7 to day-28 mortality (HR 1.00, CI 0.89-1.12, P = 0.98). Early nutrition increased VAP risk over the 28 days (HR 1.08, CI 1.00-1.17, P = 0.046) and until day 7 (HR 7.17, CI 6.27-8.19, P < 0.001) but decreased VAP risk from days 7 to 28 (HR 0.85, CI 0.78-0.92, P < 0.001). Compared to parenteral feeding, enteral feeding was associated with a slightly increased VAP...Continue Reading

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Citations

Dec 2, 2015·Anaesthesia·Y Ali AbdelhamidA M Deane
Aug 5, 2016·Intensive Care Medicine·Pierre SingerGordon Doig
Feb 28, 2016·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Kirsten Schlein
Dec 12, 2017·F1000Research·Jean-Francois TimsitBruno Mourvllier
Apr 23, 2019·JPEN. Journal of Parenteral and Enteral Nutrition·Maelle MartinJean Baptiste Lascarrou
May 29, 2019·Critical Care Medicine·Anja RybitschkaRaoul Sutter
Jun 18, 2020·Medicina·Ewa StachowskaKarolina Skonieczna-Żydecka
May 5, 2017·Intensive Care Medicine·Demosthenes MakrisSaad Nseir
Feb 14, 2020·JPEN. Journal of Parenteral and Enteral Nutrition·Jayshil J PatelDaren K Heyland
Apr 7, 2019·Critical Care : the Official Journal of the Critical Care Forum·Saad NseirJean Reignier
Oct 7, 2020·Yeungnam University Journal of Medicine·Chang Yeon Jung, Jung Min Bae
Feb 10, 2021·Critical Care Nurse·Jan Powers
Sep 1, 2021·Nutrition in Clinical Practice : Official Publication of the American Society for Parenteral and Enteral Nutrition·Nicole C RuizFrederick A Moore
Oct 3, 2021·JPEN. Journal of Parenteral and Enteral Nutrition·Ander Dorken GallastegiApril E Mendoza

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