Early Enteral Nutrition and Clinical Outcomes in COPD Patients Requiring Mechanical Ventilation
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Abstract
Early commencement of enteral nutrition (EEN) in critically ill patients requiring mechanical ventilation may improve outcomes. But there is a lack of enough data regarding EEN effects on COPD exacerbation patients’ outcomes. This retrospective study involved 129 COPD exacerbation patients who received invasive mechanical ventilation in ICU. The clinical outcomes were compared based on the timing of enteral nutrition (<48h vs >48h) during 60 days of ICU stay. We surveyed and analyzed mortality, pleural effusion, ventilator-associated pneumonia, weaning failure, cardiac arrhythmias, GI bleeding, electrolyte imbalances, renal dysfunction and length of ICU stay. All analyses were performed using SPSS software version 22.0. 129 COPD-exacerbated patients (EEN group n=66; DEN group n=63) who met the inclusion criteria were enrolled in the study. EEN group had a lower death rate (39% vs 44.4%) than the DEN group, but no significant difference was found in the overall mortality during the 60-day follow-up (P 0.561). The EEN group also had lower ICU stay and pleural effusion rate than the DEN group (P:0.006 and 0.020 respectively). No significant differences were found in other outcomes. Early enteral nutrition might be associated with shorter ICU stay and lower odd ratio of acquisition of pleural effusion in COPD patients requiring invasive mechanical ventilation. EEN could not decrease mortality rate compared with DEN in the current study.
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13. Brown H, Dodic S, Goh SS, Green C, Wang WC, Kaul S, et al. Factors associated with hospital mortality in critically ill patients with exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2018;13:2361-6.
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15. Hegazi RA, Wischmeyer PE. Clinical review: Optimizing enteral nutrition for critically ill patients--a simple data-driven formula. Crit Care 2011;15:234.
16. Yazdanpanah L, Shidfar F, Moosavi AJ, Heidarnazhad H, Haghani H. Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Acta Med Iran 2010:374-9.
17. Gadre SK, Duggal A, Mireles-Cabodevila E, Krishnan S, Wang XF, Zell K, et al. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore) 2018;97:e0487.
18. Padilla PF, Martínez G, Vernooij RW, Urrútia G, Figuls MRI, Cosp XB. Early enteral nutrition (Within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults. Cochrane Database Syst Rev 2019;2019:CD012340.
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22. Akkermans RP, Biermans M, Robberts B, ter Riet G, Jacobs A, van Weel C, et al. COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers. Eur Respir J 2014;43:54-63.
23. Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29:1033-56.
24. Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med 2012;4:31-52.
25. Mohammadreza S, Sirous J, Lida G, Hossein Malekafzali A, Alireza A, Mohammad Taghi B, et al. Ventilator-associated Pneumonia: Multidrug Resistant Acinetobacter vs. Extended Spectrum Beta Lactamase-producing Klebsiella. J Infect Dev Ctries 2020;14:660-3.
26. Zheng XX, Jiang LX, Huang M. Early versus delayed enteral nutrition in critically ill patients: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2019;12:4755-63.
27. Li PF, Wang YL, Fang YL, Nan L, Zhou J, Zhang D. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumatol 2020;23:163-7.
28. Bediwy AS, Al-Biltagi M, Saeed NK, Bediwy HA, Elbeltagi R. Pleural effusion in critically ill patients and intensive care setting. World J Clin Cases 2023;11:989-99.
29. Razazi K, Boissier F, Neuville M, Jochmans S, Tchir M, May F, et al. Pleural effusion during weaning from mechanical ventilation: a prospective observational multicenter study. Ann Intensive Care 2018;8:103.
30. Maslove DM, Chen BT, Wang H, Kuschner WG. The diagnosis and management of pleural effusions in the ICU. J Intensive Care Med 2013;28:24-36.
31. Beigmohammadi MT, Khan ZH, Samadi S, Mahmoodpoor A, Fotouhi A, Rahimiforoushani A, et al. Role of hematocrit concentration on successful extubation in critically ill patients in the intensive care units. Anesth Pain Med 2016;6:e32904.
32. Amado CA, García-Unzueta MT, Fariñas MC, Santos F, Ortiz M, Muñoz-Cacho P, et al. Vitamin D nutritional status and vitamin D regulated antimicrobial peptides in serum and pleural fluid of patients with infectious and noninfectious pleural effusions. BMC Pulm Med 2016;16:99.
33. Dehesa-López E, Martínez-Felix JI, Inzunza-Soto MY, Sánchez-Ochoa JÁ, de los Angeles Espinoza-Cuevas M, Valdez-Ortiz R. Clinical impact of disease-related malnutrition and fluid overload assessment via bioimpedance vector analysis in hospitalized patients. Clin Nutr ESPEN 2020;39:131-6.
2. Brisard L, Le Gouge A, Lascarrou JB, Dupont H, Asfar P, Sirodot M, et al. Impact of early enteral versus parenteral nutrition on mortality in patients requiring mechanical ventilation and catecholamines: study protocol for a randomized controlled trial (NUTRIREA-2). Trials 2014;15:507.
3. Preiser JC, Arabi YM, Berger MM, Casaer M, McClave S, Montejo-González JC, et al. A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice. Crit Care 2021;25:424.
4. Mehta Y, Sunavala JD, Zirpe K, Tyagi N, Garg S, Sinha S, et al. Practice Guidelines for Nutrition in Critically Ill Patients: A Relook for Indian Scenario. Indian J Crit Care Med 2018;22:263-73.
5. Artinian V, Krayem H, DiGiovine B. Effects of early enteral feeding on the outcome of critically ill mechanically ventilated medical patients. Chest 2006;129:960-7.
6. Doig GS, Heighes PT, Simpson F, Sweetman EA, Davies AR. Early enteral nutrition, provided within 24 h of injury or intensive care unit admission, significantly reduces mortality in critically ill patients: a meta-analysis of randomised controlled trials. Intensive Care Med 2009;35:2018-27.
7. Sierra-Colomina M, Yehia NA, Mahmood F, Parshuram C, Mtaweh H. A Retrospective Study of Complications of Enteral Feeding in Critically Ill Children on Noninvasive Ventilation. Nutrients 2023;15:2817.
8. Lewis SR, Schofield‐Robinson OJ, Alderson P, Smith AF. Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit. Cochrane Database Syst Rev 2018;6:CD012276.
9. Tian F, Heighes PT, Allingstrup MJ, Doig GS. Early Enteral Nutrition Provided Within 24 Hours of ICU Admission: A Meta-Analysis of Randomized Controlled Trials. Crit Care Med 2018;46:1049-56.
10. Collins PF, Yang IA, Chang YC, Vaughan A. Nutritional support in chronic obstructive pulmonary disease (COPD): an evidence update. J Thorac Dis 2019;11:S2230-S7.
11. Nan Y, Zhou Y, Dai Z, Yan T, Zhong P, Zhang F, et al. Role of nutrition in patients with coexisting chronic obstructive pulmonary disease and sarcopenia. Front Nutr 2023;10:1214684.
12. Bernardes S, Eckert IDC, Burgel CF, Teixeira PJZ, Silva FM. Increased energy and/or protein intake improves anthropometry and muscle strength in chronic obstructive pulmonary disease patients: a systematic review with meta-analysis on randomised controlled clinical trials. Br J Nutr 2023;129:1332-49.
13. Brown H, Dodic S, Goh SS, Green C, Wang WC, Kaul S, et al. Factors associated with hospital mortality in critically ill patients with exacerbation of COPD. Int J Chron Obstruct Pulmon Dis 2018;13:2361-6.
14. Collins PF, Elia M, Stratton RJ. Nutritional support and functional capacity in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Respirology 2013;18:616-29.
15. Hegazi RA, Wischmeyer PE. Clinical review: Optimizing enteral nutrition for critically ill patients--a simple data-driven formula. Crit Care 2011;15:234.
16. Yazdanpanah L, Shidfar F, Moosavi AJ, Heidarnazhad H, Haghani H. Energy and protein intake and its relationship with pulmonary function in chronic obstructive pulmonary disease (COPD) patients. Acta Med Iran 2010:374-9.
17. Gadre SK, Duggal A, Mireles-Cabodevila E, Krishnan S, Wang XF, Zell K, et al. Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease (COPD). Medicine (Baltimore) 2018;97:e0487.
18. Padilla PF, Martínez G, Vernooij RW, Urrútia G, Figuls MRI, Cosp XB. Early enteral nutrition (Within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults. Cochrane Database Syst Rev 2019;2019:CD012340.
19. Moon SJ, Ko RE, Park CM, Suh GY, Hwang J, Chung CR. The Effectiveness of Early Enteral Nutrition on Clinical Outcomes in Critically Ill Sepsis Patients: A Systematic Review. Nutrients 2023;15:3201.
20. Delanaye P, Schaeffner E, Ebert N, Cavalier E, Mariat C, Krzesinski JM, et al. Normal reference values for glomerular filtration rate: what do we really know? Nephrol Dial Transplant 2012;27:2664-72.
21. Fuentes Padilla P, Martínez G, Vernooij RW, Urrútia G, Roqué IFM, Bonfill Cosp X. Early enteral nutrition (within 48 hours) versus delayed enteral nutrition (after 48 hours) with or without supplemental parenteral nutrition in critically ill adults. Cochrane Database Syst Rev. 2019;2019:CD012340.
22. Akkermans RP, Biermans M, Robberts B, ter Riet G, Jacobs A, van Weel C, et al. COPD prognosis in relation to diagnostic criteria for airflow obstruction in smokers. Eur Respir J 2014;43:54-63.
23. Boles J-M, Bion J, Connors A, Herridge M, Marsh B, Melot C, et al. Weaning from mechanical ventilation. Eur Respir J 2007;29:1033-56.
24. Karkhanis VS, Joshi JM. Pleural effusion: diagnosis, treatment, and management. Open Access Emerg Med 2012;4:31-52.
25. Mohammadreza S, Sirous J, Lida G, Hossein Malekafzali A, Alireza A, Mohammad Taghi B, et al. Ventilator-associated Pneumonia: Multidrug Resistant Acinetobacter vs. Extended Spectrum Beta Lactamase-producing Klebsiella. J Infect Dev Ctries 2020;14:660-3.
26. Zheng XX, Jiang LX, Huang M. Early versus delayed enteral nutrition in critically ill patients: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2019;12:4755-63.
27. Li PF, Wang YL, Fang YL, Nan L, Zhou J, Zhang D. Effect of early enteral nutrition on outcomes of trauma patients requiring intensive care. Chin J Traumatol 2020;23:163-7.
28. Bediwy AS, Al-Biltagi M, Saeed NK, Bediwy HA, Elbeltagi R. Pleural effusion in critically ill patients and intensive care setting. World J Clin Cases 2023;11:989-99.
29. Razazi K, Boissier F, Neuville M, Jochmans S, Tchir M, May F, et al. Pleural effusion during weaning from mechanical ventilation: a prospective observational multicenter study. Ann Intensive Care 2018;8:103.
30. Maslove DM, Chen BT, Wang H, Kuschner WG. The diagnosis and management of pleural effusions in the ICU. J Intensive Care Med 2013;28:24-36.
31. Beigmohammadi MT, Khan ZH, Samadi S, Mahmoodpoor A, Fotouhi A, Rahimiforoushani A, et al. Role of hematocrit concentration on successful extubation in critically ill patients in the intensive care units. Anesth Pain Med 2016;6:e32904.
32. Amado CA, García-Unzueta MT, Fariñas MC, Santos F, Ortiz M, Muñoz-Cacho P, et al. Vitamin D nutritional status and vitamin D regulated antimicrobial peptides in serum and pleural fluid of patients with infectious and noninfectious pleural effusions. BMC Pulm Med 2016;16:99.
33. Dehesa-López E, Martínez-Felix JI, Inzunza-Soto MY, Sánchez-Ochoa JÁ, de los Angeles Espinoza-Cuevas M, Valdez-Ortiz R. Clinical impact of disease-related malnutrition and fluid overload assessment via bioimpedance vector analysis in hospitalized patients. Clin Nutr ESPEN 2020;39:131-6.
| Files | ||
| Issue | Vol 61 No 9 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/acta.v61i9.15286 | |
| Keywords | ||
| Nutrition Chronic obstructive pulmonary disease enteral feeding Critical illness Patient outcome | ||
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How to Cite
1.
Mansouri F, Akrami M, Faraji N, Nataj Majd M. Early Enteral Nutrition and Clinical Outcomes in COPD Patients Requiring Mechanical Ventilation. Acta Med Iran. 2024;61(9):547-554.
