+ What to Do When Early Enteral Feeding is Not Possible in Critically Ill Patients? Results of a Multicenter Observational Study Naomi E Cahill RD MSc Queens University, Kingston ON 10 February 2010 + Acknowledgements Co-authors Lauren Murch, Dr Khursheed Jeejeebhoy, Dr Stephen A. McClave, Andrew G. Day, Miao Wang, Dr Daren K. Heyland Participants of the International Nutrition Surveys Research Team at the Clinical Evaluation Research Unit + Background + What is the best course of action when early EN is not possible? Delay EN Start PN Early Start PN Late + Objective To evaluate the effect of early parenteral nutrition (PN) ( 48 hours) on nutritional and clinical outcomes in critically ill medical patients who received late EN. + International Nutrition Survey 2007 and 2008 Prospective observational cohort study 20 consecutive adult critically ill patients per ICU Mechanically ventilated within 48 hours Remained in ICU >72 hours Data collected Hospital and ICU characteristics Patients baseline information Age, admission diagnosis, APACHE II score Baseline nutrition assessment 12 days of daily nutrition data Type of nutrition, amount received 60 day hospital outcomes Mortality, length of stay + Statistical Analysis Descriptive statistics Late EN vs. Early PN vs. Late PN Time to hospital discharge alive Kaplan-Meier figures Cox-proportional hazards model Adjusting for age, admission diagnosis, time in hospital prior to ICU admission, APACHE II score, year of the study, geographic region, and presence of an ICU Medical Director Study Population + Results: Patient Characteristics age sex APACHE II score presence of Acute Respiratory Distress Syndrome (ARDS) types of admission diagnosis duration of hospital stay prior to ICU admission No Significant Differences Significant Differences + Adequacy of Calories from Total Nutrition (EN+PN+Propofol) Late ENEarly PNLate PNP-value 42.9%21.2%74.1%21.2%53.2%22.7%