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CONTEXT: The amount of enteral nutrition patients with acute lung injury need is unknown.OBJECTIVE: To determine if initial lower-volume trophic enteral feeding would increase ventilator-free days and decrease gastrointestinal intolerances compared with initial full enteral feeding.DESIGN, SETTING, AND PARTICIPANTS: The EDEN study, a randomized, open-label, multicenter trial conducted from January 2, 2008, through April 12, 2011. Participants were 1000 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network.INTERVENTIONS: Participants were randomized to receive either trophic or full enteral feeding for the first 6 days. After day 6, the care of all patients who were still receiving mechanical ventilation was managed according to the full feeding protocol.MAIN OUTCOME MEASURES: Ventilator-free days to study day 28.RESULTS: Baseline characteristics were similar between the trophic-feeding (n = 508) and full-feeding (n = 492) groups. The full-feeding group received more enteral calories for the first 6 days, about 1300 kcal/d compared with 400 kcal/d (P < .001). Initial trophic feeding did not increase the number of ventilator-free days (14.9 [95% CI, 13.9 to 15.8] vs 15.0 [95% CI, 14.1 to 15.9]; difference, -0.1 [95% CI, -1.4 to 1.2]; P = .89) or reduce 60-day mortality (23.2% [95% CI, 19.6% to 26.9%] vs 22.2% [95% Tiffany Co Brisbane
CI, 18.5% to 25.8%]; difference, 1.0% [95% CI, -4.1% to 6.3%]; P = .77) compared with full feeding. Buy Tiffany Chairs Australia
There were no differences in infectious complications between the groups. Despite receiving more prokinetic agents, the full-feeding group experienced more vomiting (2.2% vs 1.7% of patient feeding days; P = .05), elevated gastric residual volumes (4.9% vs 2.2% of feeding days; P < .001), and constipation (3.1% vs 2.1% of feeding days; P = .003). Mean plasma glucose values and average hourly insulin administration were both higher in the full-feeding group over the first 6 days.CONCLUSION: In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance.TRIAL REGISTRATION: clinicaltrials.gov Identifiers: NCT00609180 and NCT00883948.Comment inNutrition for critically ill patients: how much is enough? [JAMA. 2012]Nutrition for critically ill patients: how much is enough?Griffiths RD. JAMA. 2012 Feb 22; 307(8):845-6. Epub 2012 Feb 5.Feeding, simvastatin, and linezolid. [Am J Respir Crit Care Med. 2012]Feeding, simvastatin, and linezolid.Kamdar BB, Akulian JA, Braun AT. Am J Respir Crit Care Med. 2012 Jul 15; 186(2):195-6.