Does initial trophic feeding, as compared with full feeding, affect long-term outcomes in critically ill patients with acute lung injury?
There were no significant long-term differences in physical function, survival, psychological symptoms, or cognitive function in patients with acute lung injury who received initial trophic feeding as compared with full enteral feeding. (LOE = 1b)
Needham DM, Dinglas VD, Bienvenu OJ, et al, for the NIH NHLBI ARDS Network. One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial. BMJ 2013;346:f1532.
Randomized controlled trial (nonblinded)
Inpatient (any location) with outpatient follow-up
Low-energy permissive underfeeding, or "trophic feeding," is one proposed nutritional strategy for mechanically ventilated patients. The previously published EDEN trial showed no significant differences in short-term mortality or ventilation-free days in patients with acute lung injury who received initial trophic feeding versus full enteral feeding (Rice, et al. JAMA 2012;307(8):795-803). In this follow-up of the EDEN trial, investigators examined the long-term effects of this intervention. The patients included in the EDEN trial had acute lung injury primarily due to pneumonia or sepsis and had a mean age of 52 years. The patients were randomized to either full feeding (meeting 80% of the caloric goal) or trophic feeding (meeting 25% of the caloric goal) for up to 6 days. Of the 951 patients in the initial EDEN trial, 563 consented to this follow-up study. Research staff interviewed the surviving participants at 6 months (n = 514) and at 12 months (n = 487). Taken together, these patients had decreased physical and mental abilities as compared with population norms, impaired quality of life and return to work, and increased psychological symptoms. When comparing the full feeding cohort with the patients that received trophic feeding, there was no significant difference in the primary outcome of physical function at 6 or 12 months as assessed by the Short-form Health Outcomes Survey (SF-36). The SF-36 mental health measures favored the trophic feeding group at 12 months, but the differences in scores were small. Overall, there were no differences in specific psychological symptoms -- such as anxiety or depression, 12-month survival, cognitive function, or employment status -- between the 2 groups.
Dr. Kulkarni is an assistant professor of hospital medicine at Northwestern University in Chicago.