Eur J Med Res. 2025 Apr 22;30(1):315. doi: 10.1186/s40001-025-02579-3.
ABSTRACT
BACKGROUND AND OBJECTIVE: The timing of enteral nutrition initiation in critically ill patients in the intensive care unit (ICU) plays a crucial role in clinical outcomes. This study aimed to evaluate the impact of early (within 48 h of ICU admission) versus delayed enteral feeding on 28-day mortality, ventilator dependency, and ICU length of stay.
METHODS: A retrospective cohort study was conducted involving 295 patients across four ICUs in two Tehran hospitals, admitted between 2017 and 2018. Participants were grouped into early (n = 161) and delayed (n = 134) enteral feeding categories. Baseline characteristics were analyzed using the Mann-Whitney and Chi-Square tests. Mortality was assessed using Kaplan-Meier survival analysis and Cox proportional hazards models, while logistic and linear regression models were applied to examine associations with ventilator dependency and ICU length of stay, respectively.
RESULTS: Early enteral feeding (EEF) was significantly associated with reduced 28-day mortality (25.5% vs. 50.0%, p < 0.001), lower incidence of mechanical ventilation (66.5% vs. 80.6%, p = 0.007), and a shorter ICU stay (13.07 ± 16.44 days vs. 16.23 ± 13.57 days, p < 0.001). Kaplan-Meier analysis revealed a higher survival probability at 28 days in the early feeding group (log-rank test, p < 0.001). However, after adjusting for potential confounders (age, gender, BMI, baseline APACHEII, baseline SOFA score, number of comorbid, primary diagnosis and admission category), the relationships between delayed feeding and mortality (HR: 1.49, 95% CI 0.98, 2.26, p = 0.062), ventilator dependency (OR: 1.28, 95% CI 0.59, 2.70, p = 0.558), and ICU length of stay (LOS) (β: 1.96, 95% CI – 1.52, 5.45, p = 0.268) were not statistically significant. Subgroup analyses revealed that delayed enteral feeding was significantly associated with higher mortality risk in surgical patients (adjusted HR: 1.85, 95% CI 1.02, 3.35, p = 0.043) and prolonged ICU stay (β: 3.75, 95% CI 0.27, 7.23, p = 0.035), whereas no significant associations were observed in medical patients.
CONCLUSION: Initiating enteral feeding within 48 h of ICU admission is associated with improved clinical outcomes, although these benefits may be influenced by individual patient factors and disease severity. Future studies should focus on tailoring enteral feeding strategies to optimize outcomes across varied ICU populations.
PMID:40259420 | DOI:10.1186/s40001-025-02579-3
