Enteral Nutrition Delivery Methods and Clinical Outcomes in Critically Ill Patients: A Retrospective Cohort Study

Area of Science:

• Critical care medicine
• Clinical nutrition
• Intensive care unit (ICU) management

Background:

• Enteral nutrition is vital for critically ill patients, but optimal delivery methods are debated.
• Volume-based feeding was hypothesized to improve caloric delivery compared to rate-based or mixed strategies.
• Outcomes in real-world settings, especially for COVID-19 patients, require further investigation.

Purpose of the Study:

• To compare the effectiveness of rate-based, volume-based, and mixed enteral nutrition strategies.
• To assess the impact of different feeding strategies on caloric delivery and clinical outcomes in ICU patients.
• To investigate if critically ill COVID-19 patients achieve lower nutritional goals.

Main Methods:

• A retrospective cohort study of 324 ICU patients receiving enteral nutrition for ≥48 hours.
• Categorization into rate-based, volume-based, or mixed feeding strategies.
• Primary outcome: percentage of prescribed caloric intake achieved; secondary outcomes: length of stay, ventilator days, pressure injuries, infections.

Main Results:

• No significant difference in achieving ≥80% caloric goal across feeding strategies (24% overall).
• Mixed feeding associated with longer hospital/ICU stays, more ventilator days, and longer nutrition duration.
• Mixed feeding linked to higher pressure injury rates; COVID-19 status did not alter these findings.

Conclusions:

• Volume-based enteral nutrition did not improve total energy delivery compared to other strategies.
• Mixed feeding strategies correlated with adverse clinical outcomes, potentially due to patient complexity.
• Consistent enteral nutrition delivery may be more critical than the specific protocol type.