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Published on: June 12, 2021
Early Enteral Nutrition May Improve Survival in Patients With Cardiogenic Shock
Liangliang Zheng1, Jingwei Duan2, Baomin Duan3
1Emergency Department, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.
Insights
Early enteral nutrition (EEN) improves survival outcomes for patients with cardiogenic shock (CS) without increasing adverse events. This approach also reduces hospital stays, offering a safer and more effective feeding strategy for critically ill CS patients.
Area of Science:
- Critical Care Medicine
- Gastroenterology
- Cardiology
Background:
- International guidelines advocate for early enteral nutrition (EEN) in critically ill patients.
- Optimal timing of EN in cardiogenic shock (CS) patients remains under-researched.
- This study investigates the impact of EEN versus delayed EN in CS patients.
Purpose of the Study:
- To compare clinical outcomes and safety of EEN versus delayed EN in CS patients.
- To evaluate the association between EEN and survival rates in CS.
- To assess the risk of adverse gastrointestinal events with EEN in CS.
Main Methods:
- Retrospective cohort study utilizing the MIMIC-IV database (v2.2).
- 1:1 propensity score-matched analysis comparing EEN (within 2 days) and delayed EN groups.
- Adjusted proportional hazards regression models to confirm survival associations.
Main Results:
- After matching, 409 patients were in each group (EEN and delayed EN).
- EEN was associated with significantly improved 30-, 90-, and 180-day survival rates (HRs < 1, p < 0.05).
- EEN did not increase risks for ileus, aspiration pneumonia, or GI bleeding; hospital stays were shorter with EEN (12 vs. 17 days, p < 0.001).
Conclusions:
- Early enteral nutrition (EEN) is safe and associated with improved survival in cardiogenic shock (CS) patients.
- EEN does not elevate risks of common gastrointestinal complications.
- Findings suggest EEN is a beneficial nutritional strategy for CS patients, warranting further investigation.
Abstract:
Background and Aim: International guidelines recommend early enteral nutrition (EEN) for critically ill patients. However, evidence supporting the optimal timing of EN in patients diagnosed with cardiogenic shock (CS) is lacking. As such, this study aimed to compare the clinical outcomes and safety of EEN versus delayed EN in patients diagnosed with CS. Methods: This retrospective cohort study was conducted using data from the Medical Information Mart for Intensive Care IV version 2.2 database. Patients who received EN within 2 days of admission were assigned to the EEN group. A 1:1 propensity score-matched (PSM) analysis was performed to control for bias in baseline characteristics and ensure the reliability of the results. To exclude the impact of confounders, an adjusted proportional hazards regression model was used to verify the independence between EEN and survival outcomes. Results: Of 1846 potentially eligible patients, 1398 received EEN and 448 received delayed EN. After 1:1 PSM, 818 patients were assigned to the EEN (n = 409) and delayed EN (n = 409) groups. Regarding cumulative survival, patients with CS receiving EEN experienced better 30-, 90-, and 180-day survival outcomes than the delayed EN group (hazard ratio [HR] 0.803 [95% confidence interval [CI] 0.647-0.998], p=0.045; HR 0.729 [95% CI 0.599-0.889], p=0.001; and HR 0.778 [95% CI 0.644-0.938], p=0.008, respectively). After adjusting for confounders, EEN was found to be independently associated with survival outcomes. Moreover, EEN did not increase the risk(s) for ileus, aspiration pneumonia, or gastrointestinal bleeding. Patients who received delayed EN experienced longer hospital stays than those receiving EEN (17 days [interquartile range [IQR] 10-25] versus 12 days [IQR 7-19 days], respectively; p < 0.001). Conclusion: EEN was not associated with harm, but rather with improved survival outcomes in patients diagnosed with CS. Further studies are required to verify these findings.
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