Enteral nutrition in septic shock in the elderly: do the waiting time to start and the achieved basal energy expenditure interfere with mortality?

Background

The earliest starting point of enteral nutrition (EN), as well as the basal energy expenditure (BEE), achieved within as short a waiting time as possible seems to benefit quite a large number of critical patients.

Objectives

To analyze when to start EN and the BEE achieved in the elderly hospitalized with a septic shock diagnosis, and to verify its association with mortality in these patients.

Methods

A prospective cohort conducted within 32 months and with 67 patients over 65 years old in the ICU with septic shock, where 59 of these patients had EN. The APACHE II score was determined in every patient. The following variables were analyzed in this group: the time taken to start the NE, the BEE (achieved or not), and the time to reach the BEE in those who had it. These variables were correlated with death and it was still observed whether there was correlation between the starting time point of EN and the achieved BEE. The statistical tests used were the t test and the chi-square test, considering 5% as the significance level.

Results

The average age was 80 ± 7 (minimum = 66, maximum = 96) years, the APACHE II average score was 18 ± 5 (minimum = 8, maximum = 28), and the time average to start EN was 80 ± 53 hours (minimum of 12 hours and maximum of 240 hours). The achieved BEE occurred in 69.5% (n = 41) of the patients and the time average to reach it was 115 ± 56 hours (minimum of 72 hours and maximum of 360 hours). Death was associated with time to start EN (P = 0.001) and with the non-achieved BEE (P < 0.001). However, there was no correlation with time to reach BEE (P = 0.22). The time to start EN did not show association with the achieved BEE (P = 0.08).

Conclusions

Initiating EN as soon as possible and the BEE when achieved in this group of patients showed some benefit. The time to achieve the BEE does not seem to have correlation with mortality in these patients. The time to start NE did not have association with the BEE achieved in this sample.