The Latest in Critical Care, 7/17/23 (Issue #9)
Should enteral feedings be stopped prior to extubation attempts?
Tube feedings are often interrupted in mechanically ventilated patients being considered for extubation, in the hope this will reduce risk for aspiration and extubation failure. It makes sense, but does stopping tube feedings help? Or could it be harmful, resulting in inadequate nutrition being delivered?
At 22 ICUs in France, 1130 mechanically ventilated patients already receiving enteral feedings were cluster-randomized (i.e., by center) to have feeds stopped 6 hours before and their gastric tubes suctioned prior to extubation, or continued feedings and no suctioning. At 7 days after extubation, nearly identical numbers of patients (in the intention-to-treat analysis) had been reintubated or had died (17.2% vs 17.5%). The findings met the prespecified threshold for non-inferiority margin set at 10%.
Patients whose enteral feedings continued received significantly more calories. They also had a lower incidence of pneumonia…
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