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Published on: June 28, 2018
Enteral nutrition volume is not correlated with lower respiratory tract infection in patients on mechanical
A Colomar1, B Guardiola1, J A Llompart-Pou1
1Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain.
Objective:
To evaluate the effect of enteral nutrition volume, gastrointestinal function and the type of acid suppressive drug upon the incidence of lower respiratory tract infections in critically ill patients on mechanical ventilation (MV).
Design:
A retrospective secondary analysis was carried out.
Setting:
The Intensive Care Unit of a University Hospital.
Patients Or Participants:
Patients≥18-years-old expected to need MV for more than four days, and receiving enteral nutrition by nasogastric tube within 24h of starting MV.
Interventions:
We correlated enteral nutrition volume administered during the first 10 days, gastrointestinal function and the type of acid suppressive therapy with the episodes of lower respiratory tract infection up until day 28. Cox proportional hazards ratios in univariate and adjusted multivariate models were used. Statistical significance was considered for p<0.05.
Main Variables Of Interest:
Lower respiratory tract infection episodes.
Results:
Sixty-six out of 185 patients (35.7%) had infection; 27 patients had ventilator-associated pneumonia; and 39 presented ventilator-associated tracheobronchitis. Uninfected and infected groups were similar in terms of enteral nutrition volume (54±12 and 54±9mL/h; p=0.94) and caloric intake (19.4±4.9 and 19.6±5.2kcal/kg/d; p=0.81). The Cox proportional hazards model showed neurological indication of MV to be the only independent variable related to infection (p=0.001). Enteral nutrition volume, the type of acid suppressive therapy, and the use of prokinetic agents were not significantly correlated to infection.
Conclusions:
Enteral nutrition volume and caloric intake, gastrointestinal dysfunction and the type of acid suppressive therapy used were not associated to lower respiratory tract infection in patients on MV.
Insights
Enteral nutrition volume and acid suppressive drugs do not impact lower respiratory tract infections in mechanically ventilated patients. Neurological indication for mechanical ventilation (MV) was the only significant factor identified.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Gastroenterology
Background:
- Lower respiratory tract infections (LRTIs) are a significant concern in critically ill patients requiring mechanical ventilation (MV).
- Factors influencing LRTI incidence, including nutritional support and acid suppression, require further investigation.
Purpose of the Study:
- To evaluate the impact of enteral nutrition volume, gastrointestinal function, and acid suppressive drug type on LRTI incidence in mechanically ventilated patients.
- To identify independent predictors of LRTI in this patient population.
Main Methods:
- Retrospective secondary analysis of data from a university hospital intensive care unit.
- Inclusion criteria: patients ≥18 years old, expected MV >4 days, receiving enteral nutrition within 24h of MV initiation.
- Correlation analysis of enteral nutrition, gastrointestinal function, acid suppressive therapy with LRTI episodes up to day 28 using Cox proportional hazards models.
Main Results:
- 35.7% of patients (66/185) developed LRTI, including ventilator-associated pneumonia and tracheobronchitis.
- No significant difference in enteral nutrition volume or caloric intake between infected and uninfected groups.
- Neurological indication for MV was the sole independent predictor of LRTI (p=0.001); enteral nutrition, acid suppression, and prokinetics were not significant.
Conclusions:
- Enteral nutrition volume, caloric intake, gastrointestinal dysfunction, and acid suppressive therapy type are not associated with LRTI in mechanically ventilated patients.
- Neurological indication for MV is a key risk factor for LRTI in this cohort.
- Further research may be needed to elucidate other contributing factors to LRTI in critically ill patients on MV.
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