Medical News Stories
A Cohort Study of Nutrition Practices in the Intensive Care Unit Following Abdominal Aortic Aneurysm Repair
Study Question(s): Is early feeding (within 48 hours of ICU admission) post-abdominal aortic aneurysm (AAA) repair achievable and well tolerated? What factors predict early feeding? Does early feeding affect in-hospital mortality?
Study Description: This retrospective study used a local vascular surgery database to identify patients who had an AAA repair and were admitted to the ICU within 48 hours. Nutrition data were collected through the first 14 days of each patient’s ICU stay, and a gastric residual protocol, which included prokinetic agents for residuals >250 mL, was employed. The study’s primary outcome was feeding within 48 hours of ICU admission.
Results: A total of 145 patients were included in the study, and 35 (24%) achieved the primary outcome with a median time to enteral nutrition (EN) initiation of 74 hours. There was no significant difference in feed intolerance between the early and delayed EN groups. The strongest predictor of ability to tolerate early feeding was when patients underwent an endovascular (as opposed to open) repair. Other factors that predicted early feeding were male sex, < 4 L of blood loss in the OR, and < 48 hours on the ventilator. Mortality at 14 days was not related to the timing of feeding.
Conclusions: Patients who have endovascular AAA repair and a shorter duration of mechanical ventilation are the ones who are most likely to be fed within 48 hours of ICU admission, and there is no significant difference in feed intolerance based on time of EN initiation. Early feeding after AAA repair does not affect 14-day mortality.
Perspective: Initiation of nutrition within 48 hours of ICU admission is associated with improved outcomes in ICU patients, but there were few data in post-op AAA repair prior to this study. Although early feeding in this study was reported to be well tolerated and did not affect mortality, the observational nature of this small study necessitates prospective, randomized trials to further delineate the benefits of early nutrition post-AAA repair, as well as the best ways to achieve it.