The Impact of the Adequacy and Interruption of Enteral Nutrition on Clinical Outcomes within Ventilated, Critically-Ill Neurological Patients. SD Dobak, F Rincon. Department of Neurosurgery, Thomas Jefferson University,
Nutrition plays a vital role within critically ill patients. It is hypothesized that relationships exist between enteral nutrition (EN) interruptions and calorie intake, calorie intake and clinical outcomes, and EN interruptions and ventilated associated pneumonia (VAP) among neurointensive care unit (NICU) patients. A prospective observational study involving 27 patients suffering brain injury and requiring mechanical ventilation and EN was conducted. Data on calorie intake and EN interruptions were collected from initiation to end of intubation. Mechanical ventilation duration, hospital length of stay (LOS), NICU LOS and in-hospital mortality were recorded. Patients were dividing into two groups based on receiving >60% (Group 1) or ≤ 60% (Group 2) prescribed EN calories. Groups were similar in age (median 69 years; IQR 63-79), gender (52% male), admitting Glasgow Coma Score (median 8; IQR 7-14), and Body Mass Index (median 28 kg/m2; IQR 26-32). Group 1 (n=7) had more EN interruptions (mean 4.1; SD 0.9) than Group 2 (n=20; mean 2.8; SD 1.5) (p=0.01). Differences between mechanical ventilation duration (p=0.09), hospital LOS (p=0.09), NICU LOS (p=0.1) and in-hospital mortality (p=1.0) were observed. There were 2 incidences of aspiration pneumonia in Group 1 versus 0 in Group 2 (p=0.06). Regarding median time to place feeding tube, Group 1 had 4.5 hours (IQR 2-7) and Group 2 had 7 hours (IQR 0-26) (p= 0.8). Median time to start EN was 10 hours in Group 1 (IQR 7-20) and 12 hours in Group 2 (IR 3-40) (p=0.7). Our results lack sufficient power to detect meaningful outcomes. The majority of ventilated NICU patients were underfed. The significant relationship between underfed patients and less EN interruptions was likely due to decreased amount of feeding tubes placed, in which EN was not started. Further research is still needed to determine the relationship between EN calorie intake and clinical outcomes.