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Role of Early Enteral Nutrition in Mechanically Ventilated COVID-19 Patients
Krista Haines1,2, Virginia Parker1, Tetsu Ohnuma2
1Division of Trauma and Critical Care and Acute Care Surgery, Department of Surgery, Duke University Medical Center, Durham, NC.
Insights
Early enteral nutrition (EN) in COVID-19 patients requiring mechanical ventilation is linked to shorter ICU stays and hospital length of stays. This supports current guidelines and highlights the need for timely EN initiation for better outcomes.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Nutritional Support
Background:
- Current guidelines recommend early enteral nutrition (EN) within 24-36 hours for critically ill COVID-19 patients.
- Limited evidence exists on the impact of early EN on outcomes specifically in COVID-19 patients.
- This study evaluates the association between early EN and clinical outcomes in mechanically ventilated COVID-19 patients.
Purpose of the Study:
- To assess the association between early enteral nutrition (EN) and clinical outcomes.
- To evaluate the impact of early EN on mechanical ventilation duration, ICU length of stay (LOS), hospital LOS, and cost.
- To provide evidence supporting current recommendations for early EN in severe COVID-19.
Main Methods:
- Nationwide observational cohort study using the Premier administrative-financial database in the United States.
- Analysis of data from 75 hospitals between April and December 2020, including 861 COVID-19 patients.
- Inclusion criteria: adult COVID-19 patients admitted to ICU within 2 days and requiring mechanical ventilation within 3 days.
Main Results:
- Early EN group (n=513) showed similar baseline characteristics to the late EN group.
- Early EN was associated with significantly shorter ICU LOS (HR, 1.39), hospital LOS (HR, 1.53), and fewer mechanical ventilation days (HR, 1.25).
- The early EN group also incurred significantly lower costs (-$22,443).
Conclusions:
- Early enteral nutrition (EN) in mechanically ventilated COVID-19 patients is associated with improved clinical outcomes, including earlier liberation from ventilation and shorter lengths of stay.
- These findings support guideline recommendations for early EN initiation in critically ill COVID-19 patients.
- Nearly 40% of eligible patients did not receive early EN, underscoring the need for targeted strategies to improve its implementation and associated outcomes.
Abstract:
Current guidance recommends initiation of early enteral nutrition (early EN) within 24-36 hours of ICU admission in critically ill COVID-19 patients. Despite this recommendation, there is quite limited evidence describing the effect of early EN on outcomes in COVID-19 patients. The association between early EN (within 3 d post intubation) and clinical outcomes in adult COVID-19 patients requiring mechanical ventilation (within 2 d post ICU admission) was evaluated.
Design:
We performed a nationwide observational cohort study using a nationwide administrative-financial database (Premier) in United States.
Setting:
Information pertaining to all COVID-19 patients admitted to ICU from 75 hospitals between April and December 2020 was analyzed.
Patients:
A total of 861 COVID-19 patients were included.
Interventions:
None.
Measurements And Main Results:
Clinical outcomes were assessed via regression models to control for patient and hospital characteristics. We identified 513 COVID-19 ICU patients (59.2%) requiring mechanical ventilation who received early EN and had similar baseline characteristics to late EN group. Compared with late EN group, the early EN group had shorter ICU (hazard ratio [HR], 1.39; 95% CI, 1.15-1.68) and hospital length of stays (LOS) (HR, 1.53; 95% CI, 1.23-1.91), fewer mechanical ventilation days (HR, 1.25; 95% CI, 1.01-1.54), and lower cost (-$22,443; 95% CI, -$32,342 to -$12,534). All comparisons were statistically significant (p < 0.05).
Conclusions:
In patients with COVID-19 requiring mechanical ventilation, early EN is associated with earlier liberation from mechanical ventilation, shorter ICU and hospital LOS, and decreased cost. Our results are among the first to support guideline recommendations for initiation of early EN in COVID-19 ICU patients. Further, our data show nearly 40% of critically ill COVID-19 patients fail to have early EN initiated, even at 3 d post initiation of mechanical ventilation. These results emphasize the need for targeted strategies promoting initiation of early EN, as this may lead to improved clinical and economic outcomes in severe COVID-19 patients.
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