• Jean Reignier, Michael Darmon, Romain Sonneville, Anne-Laure Borel, Maité Garrouste-Orgeas, Stéphane Ruckly, Bertrand Souweine, Anne-Sylvie Dumenil, Hakim Haouache, Christophe Adrie, Laurent Argaud, Lilia Soufir, Guillaume Marcotte, Virginie Laurent, Dany Goldgran-Toledano, Christophe Clec'h, Carole Schwebel, Elie Azoulay, Jean-François Timsit, and OutcomeRea Network.
• Medical-Surgical Intensive Care Unit, CHD de la Vendée, La Roche-sur-Yon, France, jean.reignier@chd-vendee.fr.
• Intensive Care Med. 2015 May 1; 41 (5): 875-86.

PurposeFew data are available about optimal nutrition modalities in mechanically ventilated patients with shock. Our objective was to assess associations linking early nutrition (<48 h after intubation), feeding route and calorie intake to mortality and risk of ventilator-associated pneumonia (VAP) in patients with invasive mechanical ventilation (IMV) and shock.MethodsIn the prospective OutcomeRea database, we identified adults with IMV >72 h and shock (arterial systolic pressure <90 mmHg) within 48 h after intubation. A marginal structural Cox model was used to create a pseudo-population in which treatment was unconfounded by subject-specific characteristics.ResultsWe included 3,032 patients. Early nutrition was associated with lower day-28 mortality [HR 0.89, 95 % confidence interval (CI) 0.81-0.98, P = 0.01] and day-7 mortality (HR 0.76, CI 0.66-0.87, P < 0.001) but not with lower day-7 to day-28 mortality (HR 1.00, CI 0.89-1.12, P = 0.98). Early nutrition increased VAP risk over the 28 days (HR 1.08, CI 1.00-1.17, P = 0.046) and until day 7 (HR 7.17, CI 6.27-8.19, P < 0.001) but decreased VAP risk from days 7 to 28 (HR 0.85, CI 0.78-0.92, P < 0.001). Compared to parenteral feeding, enteral feeding was associated with a slightly increased VAP risk (HR 1.11, CI 1.00-1.22, P = 0.04) but not with mortality. Neither mortality nor VAP risk differed between early calorie intakes of ≥20 and <20 kcal/kg/day.ConclusionIn mechanically ventilated patients with shock, early nutrition was associated with reduced mortality. Neither feeding route nor early calorie intake was associated with mortality. Early nutrition and enteral feeding were associated with increased VAP risk.

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