Initial Trophic vs Full Enteral Feeding in Patients With Acute Lung Injury: The EDEN Randomized Trial
Open Access
- 5 February 2012
- journal article
- research article
- Published by American Medical Association (AMA) in JAMA
- Vol. 307 (8), 795-803
- https://doi.org/10.1001/jama.2012.137
Abstract
The amount of enteral nutrition patients with acute lung injury need is unknown. To determine if initial lower-volume trophic enteral feeding would increase ventilator-free days and decrease gastrointestinal intolerances compared with initial full enteral feeding. 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. 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. Ventilator-free days to study day 28. 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% CI, 18.5% to 25.8%]; difference, 1.0% [95% CI, −4.1% to 6.3%]; P=77) compared with full feeding. 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. 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.Keywords
This publication has 29 references indexed in Scilit:
- Enteral Omega-3 Fatty Acid, γ-Linolenic Acid, and Antioxidant Supplementation in Acute Lung InjuryJAMA, 2011
- Randomized, Placebo-controlled Clinical Trial of an Aerosolized β2-Agonist for Treatment of Acute Lung InjuryAmerican Journal of Respiratory and Critical Care Medicine, 2011
- Early versus Late Parenteral Nutrition in Critically Ill AdultsThe New England Journal of Medicine, 2011
- The Effect of Pulmonary Artery Catheter Use on Costs and Long-Term Outcomes of Acute Lung InjuryPLOS ONE, 2011
- Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failureCritical Care Medicine, 2011
- Minimal Enteral Feeding Induces Maturation of Intestinal Motor Function but Not Mucosal Growth in Neonatal DogsJournal of Nutrition, 2002
- Ventilation with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for Acute Lung Injury and the Acute Respiratory Distress SyndromeThe New England Journal of Medicine, 2000
- Small Amount of Low-Residue Diet with Parenteral Nutrition Can Prevent Decreases in Intestinal Mucosal IntegrityAnnals of Surgery, 2000
- Randomised controlled study of clinical outcome following trophic feedingArchives of Disease in Childhood: Fetal & Neonatal, 2000
- Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trialThe Lancet, 1999