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Safety of Prolonged Use of Trophic Feeds in the Critically Ill Patient
Author(s) -
Heyland Daren K.
Publication year - 2016
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607115590839
Subject(s) - general hospital , citation , medicine , university hospital , critically ill , pediatrics , library science , family medicine , intensive care medicine , computer science
Over 20 years ago, User Guides to the medical literature were published in JAMA to aid readers in how to use the medical literature in making inferences about managing patients1. To use the results of randomized clinical trials, readers were to ask themselves two important questions: 1) Are the results valid? and 2) Will the results help me in caring for my patients? In considering the answer to this last question, readers had to answer an additional question, “Were all clinically important outcomes considered?” As it relates to a recent trial of trophic feeds x 5 days vs. full feed, we ask the same question. In the original publication of the EDEN trial, investigators only reported on the shortterm outcomes (ventilator-free days, ICU and hospital mortality and time to discharge, infections etc.) and observed no difference between the two groups2. This led several authors or societies to recommend prolonged trophic feeding as the initial strategy in the ICU3,4. We posit that it is very plausible that inadequate nutrition intake during the ICU and hospital course causally relates to the functional decline observed in surviving patients5 and that such recommendations to underfeed ICU patients may cause harm.