• Michael T Vest, Paul Kolm, James Bowen, Jillian Trabulsi, Shannon L Lennon, Mary Shapero, Patty McGraw, James Halbert, and Claudine Jurkovitz.
• Michael T. Vest is an attending physician in the Pulmonary and Critical Care Section of the Department of Internal Medicine, a Value Institute Scholar at Christiana Care Value Institute, Newark, Delaware; and an assistant professor of medicine at the Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania. Paul Kolm is director of biostatistics and James Bowen was a senior system engineer at Christiana Care Value Institute. Jillian Trabulsi is an associate professor, Department of Behavioral Health and Nutrition, and Shannon L. Lennon is an associate professor, Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware. Mary Shapero is a clinical nutrition manager in the Department of Nutrition, Patty McGraw is a research nurse supervisor in the Department of Internal Medicine Research, and James Halpert is the physical therapy program manager in the Department of Physical Therapy, Christiana Care Healthcare System, Newark, Delaware. Claudine Jurkovitz is a senior physician scientist at Christiana Care Value Institute. mvest@christianacare.org.
• Am. J. Crit. Care. 2018 Mar 1; 27 (2): 136-143.

BackgroundClinical practice guidelines recommend enteral nutrition for most patients receiving mechanical ventilation. However, recently published evidence on the effect of enteral nutrition on mortality, particularly for patients who are well nourished, is conflicting.ObjectivesTo examine the association between enteral feeding and hospital mortality in critically ill patients receiving mechanical ventilation and to determine if body mass index mediates this relationship.MethodsA retrospective cohort study of patients receiving mechanical ventilation admitted to a medical intensive care unit in 2013. Demographic and clinical variables were collected. Cox proportional hazards regression was used to examine the relationship between an enteral feeding order and hospital mortality and to determine if the relationship was mediated by body mass index.ResultsOf 777 patients who had 811 hospitalizations requiring mechanical ventilation, 182 (23.4%) died in the hospital. A total of 478 patients (61.5%) received an order for enteral tube feeding, which was associated with a lower risk of death (hazard ratio, 0.41; 95% CI, 0.29-0.59). Body mass index did not mediate the relationship between mortality and receipt of an order for enteral feeding. Median stay in the unit was 3.6 days. Most deaths (72.0%) occurred more than 48 hours after admission.ConclusionThe finding of a positive association between an order for enteral feeding and survival supports enteral feeding of patients in medical intensive care units. Furthermore, the beneficial effect of enteral feeding appears to apply to patients regardless of body mass index.©2018 American Association of Critical-Care Nurses.

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