When early enteral feeding is not possible in @entity3124 XXXX : results of a multicenter observational study.

@entity1 @entity3124 @entity3147
BACKGROUND: Early enteral nutrition (EN) is the preferred strategy for feeding the @entity3124 ; however, it is not always possible to initiate EN within the recommended 24 to 48 hours. When these situations arise, controversy exists whether to start feeding early via the parenteral route or to delay feeding until EN can be provided. METHODS: A multicenter, international, observational study examined nutrition practices in intensive care units (ICUs). Eligible @entity1 were @entity3124 @entity1 with a medical diagnosis who remained in the ICU for >72 hours and received EN >48 hours after admission. Data were collected on site, including @entity1 characteristics, daily nutrition practices, and outcomes at 60 days. Nutrition and clinical outcomes were compared between 3 groups of @entity1 : (1) early @entity3147 ( @entity3147 ) (<48 hours after admission) and late EN (>48 hours after admission), (2) late @entity3147 and late EN, and (3) late EN and no @entity3147 . RESULTS: Of the 703 @entity1 who met our inclusion criteria, 541 (77.0%) medical @entity1 received late EN and no @entity3147 . In @entity1 receiving late EN and @entity3147 , 83 (11.8%) received early @entity3147 and 79 (11.2%) received late @entity3147 . Adequacy of calories and protein from total nutrition was highest in the early @entity3147 group (74.1%    21.2% and 71.5%    24.9%, respectively) and lowest in the late EN group (42.9%    21.2% and 38.7%    21.6%) (P < .001). The proportion of @entity1 dead or remaining in hospital was significantly higher for early @entity3147 compared with late EN and @entity3147 (unadjusted hazard ratio for early @entity3147 = 0.55; 95% confidence interval, 0.37-0.83, P = .015). However, this difference did not remain significant (P = .65) after adjustment for baseline characteristics. CONCLUSIONS: The results suggest that initiating @entity3147 early, when it is not possible to feed enterally early, may improve provision of calories and protein but is not associated with better clinical outcomes compared with late EN or @entity3147 .
