D. Aronowitz1, B. T. Faliks1, V. Patel1, J. Nicastro1, R. Barrera1 1North Shore University And Long Island Jewish Medical Center,Surgical Critical Care,Manhasset, NY, USA
Introduction: The association between malnutrition and poor outcomes in critically ill patients is well documented. International guidelines for the treatment of septic shock recommend early initiation of enteral nutrition. Enteral nutrition should be included in net fluid accumulation when considering a patient’s risk of fluid overload. Here we examine the impact of enteral nutrition on fluid balance in septic shock patients.
Methods: This retrospective chart review evaluated fluid balance in septic shock patients admitted to medical, surgical, neurosurgical, cardiothoracic intensive care, and/or coronary care units at Northwell Health campuses between January 2015 and December 2016. Total fluid volume received and net fluid balance were recorded from the time of admission to the time vasopressors were discontinued. “Fluid overload” was defined as having a percent fluid accumulation (PFA) of 10% or greater relative to baseline bodyweight. PFA was calculated by dividing the net fluid balance (liters) by the admission bodyweight (kilograms) and then multiplying by 100. Patients were stratified as either having received (Group 1) or not received (Group 2) enteral nutrition, either orally or via feeding tube. Appropriate statistical tests were used to compare PFA, 28-day mortality, days in the hospital and ICU, and ventilation days with a p<0.05 considered statistically significant.
Results: The charts of 100 patients were reviewed. Overall, net fluid balance was positive in 88/100 patients, with a median fluid balance of 6 liters. Forty patients were fluid overloaded in terms of PFA. Seventy-eight patients received enteral nutrition (Group 1) and the remaining 22 patients did not (Group 2). Groups 1 and 2 shared similar baseline characteristics. Mean age, BMI, and BSA in Group 1 were 73 years, 28.0, and 1.93, respectively. Mean age, BMI, and BSA in Group 2 were 76 years, 27.8, and 1.84, respectively. Median fluid balance was 5.4 liters in Group 1 and 6.5 liters in Group 2 (p = 0.89). Fluid overload (PFA ≥10%) occurred at a rate of 38.4% in Group 1 and a rate of 45.5% in Group 2 (p = 0.56).). In-hospital mortality or mortality within 28 days of discharge occurred in a total of 42/100 patients. Mortality rate appeared higher in Group 2 than Group 1 (38.5% vs. 54.5%, p = 0.18). Mean hospital days (13+18 vs. 9+12 p = 0.31), mean ICU days (15+22 vs. 6+8, p = 0.08), and average duration of mechanical ventilation were all greater in Group 1 than Group 2 (17+24 vs. 5+8 days, p = 0.02).
Conclusion: In our cohort, patients were not more or less likely to have received enteral nutrition based on age, BMI, or BSA. Fluid overload was not significantly associated with enteral feeding. When comparing mortality, days in the hospital, days in the ICU, and days on a ventilator, only duration of mechanical ventilation was significantly increased in patients who received enteral nutrition.