Is early enteral nutrition a risk factor for gastric intolerance and pneumonia?

Background: Early enteral nutrition (EN) after injury reduces septic complications, but upper digestive intolerance (UDI) occurring immediately post-trauma is a risk factor for pneumonia. Our study aimed to determine whether early intragastric feeding may lead to gastric intolerance and subsequent pneumonia in ventilated multiply injured patients. Methods: This prospective study involved two groups of patients randomized either to immediate intragastric EN, or to delayed intragastric EN started later than 24 h after admission. UDI was diagnosed when gastric residual volume, measured with a 50-ml syringe after stopping the feeding for 2 h, exceeded 200 ml at least at two consecutive measurements, and/or when vomiting occurred. Results: Out of 52 patients, 27 were included in the early EN group, and 25 in the delayed-EN group. On day 4, the early EN group received a greater amount of feeding because of intolerance problems occurring in the delayed-EN group (1175±485 ml vs. 803±545 ml). Twenty-five subjects—33% of the early EN patients and 64% of the delayed-EN patients—met the criteria for pneumonia (P=0.050). On average, patients with pneumonia were older, more severely injured, and therefore required more ventilator days and a longer stay in the intensive care unit than patients without pneumonia. Conclusions: If properly administered, early enteral nutrition can decrease the incidence of upper intestinal intolerance and nosocomial pneumonia in patients with multiple injuries.