Nutrition in critical care · How much to feed
Initial trophic vs full enteral feeding in patients with acute lung injury
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Initial trophic enteral feeding for up to 6 days |
| Control | Full enteral feeding |
| Population | 1000 patients with acute lung injury: 508 trophic and 492 full feeding |
| Follow-up | 60 days |
| Primary endpoint | Ventilator-free days to day 28 |
| Result | The full-feeding group received substantially more enteral calories over the first 6 days, but trophic feeding did not reduce ventilator-free days, 60-day mortality or infectious complications. |
| Secondary endpoints | 60-day mortality, infectious complications, gastrointestinal intolerance |
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.
The trial authors, in the published abstract
Feeding less caused no harm and was better tolerated — consistent with EPaNIC and PermiT. Collectively these trials made calorie targets in early critical illness look considerably less important than they once did.
Rice TW, Wheeler AP, Thompson BT, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 2012 Feb 22;307(8):795-803.