Impact of early enteral nutrition on ventilator associated pneumonia in intubated severe trauma patients: A propensity score-matched study

Su Wang; Xin Zhao; Qian Wang; Yongran Wu; Jiaxin Xu; Ruiting Li; Ting Zhou; Zheng Lv; Jihong Yang; Le Yang; Xiaojing Zou

doi:10.3389/fnut.2023.1172526

Impact of early enteral nutrition on ventilator associated pneumonia in intubated severe trauma patients: A propensity score-matched study

Front Nutr. 2023 Apr 12:10:1172526. doi: 10.3389/fnut.2023.1172526. eCollection 2023.

Authors

Su Wang^#¹, Xin Zhao^#¹, Qian Wang^#², Yongran Wu^#¹, Jiaxin Xu^#¹, Ruiting Li¹, Ting Zhou¹, Zheng Lv¹, Jihong Yang³, Le Yang⁴, Xiaojing Zou¹

Affiliations

¹ Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Intensive Care Unit, Wuhan Third Hospital (Tongren Hospital of Wuhan University), Wuhan, China.
³ Department of Critical Care Medicine, People's Hospital of Chongyang County, Xianning, China.
⁴ Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.

^# Contributed equally.

Abstract

Background: Early enteral nutrition (EN) is recommended for critically ill patients. However, the impact of early EN on intubated severe trauma patients remains unclear.

Methods: Severely traumatized adult patients who received invasive mechanical ventilation (MV) for more than 48 h during intensive care unit (ICU) stay at our institution between 2017 and 2022 were retrospectively included. Early EN was defined as EN initiation ≤48 h from ICU admission and late EN >48 h. Propensity score matching (PSM) analysis was used to compare outcomes between the groups. The primary endpoint was the incidence of ventilator-associated pneumonia (VAP). Multivariable logistic regression analysis was performed to identify independent predictors of delayed EN.

Results: For final analysis, 337 intubated severe trauma patients were available, including 204 (60.5%) in the early EN group and 133 (39.5%) in the late EN group. After PSM, early EN patients had a lower incidence of VAP (12.9 vs. 25.8%, p = 0.026) and a shorter length of hospital stay (21 vs. 24 days, p = 0.015) compared to late EN patients. There was no demonstrable difference in mortality between the two groups. Abdominal trauma, massive blood transfusion, and serum albumin were identified as independent risk factors for delayed EN.

Conclusion: Early EN decreased the VAP rate and reduced the length of hospital stay in invasively ventilated patients with severe trauma. Abdominal injury, massive blood transfusion and low albumin were associated with delayed EN.

Keywords: early enteral nutrition; invasive mechanical ventilation; propensity score matching (PSM); severe trauma patients; ventilator-associated pneumonia.