Underfeeding unnecessary for acute lung injury patients
medwireNews: Long-term results from a study comparing initial trophic or low-energy with full-energy enteral feeding in patients with acute lung injury show comparable outcomes in both groups.
As the initial comparison period was only 6 days, "perhaps the overall duration of differences in feeding strategies in the EDEN patients was not long enough to contribute to differences in outcomes," suggest the study authors in the BMJ.
"Alternatively, perhaps within one nutritional strategy, potential benefits were counter balanced by harms, with each mediated by different mechanisms associated with the strategy," they add.
Dale Needham (Johns Hopkins University, Baltimore, Maryland, USA) and colleagues previously published early results from the trial that showed no difference in mortality and days without ventilation after up to 6 days of trophic versus full-energy feeding in 951 patients with acute lung injury.
However, as nutritional interventions can have long-term implications, and previous studies comparing trophic with full-energy feeding have had conflicting results, the team carried out a longer-term follow up at 12 months of 796 patients enrolled in the original study.
Needham and team found that while patients in both groups had considerable physical and psychologic impairments, as well as a lower quality of life, and difficulties returning to work after acute lung injury, the type of initial feeding they received did not seem to impact their recovery.
Mean physical function scores on the short form (SF)-36 were the same at 12 months, at 55 points in both groups, and survival was also similar in the two groups, at 65% in the trophic and 63% in the full-energy feeding group.
Secondary outcomes were also very similar when the two groups were compared, although significantly more patients in the tropic group than in the full-energy feeding group were admitted to a physical rehabilitation facility over the 12 months, at 23% versus 14%.
"Further exploration of shorter term outcomes and of muscle strength and performance based physical function measures (such as the six minute walk test) could help inform this finding as trophic feeding might have short term effects or physiological effects not evaluated in this study," write Needham and co-authors.
By Helen Albert, Senior medwireNews Reporter