Early hypocaloric enteral nutritional supplementation in acute organophosphate poisoning - a prospective randomized trial

Introduction. Early institution of enteral feeds may be associated with improved outcomes in the critically ill. This study evaluated the effect of hypocaloric enteral nutritional supplementation in acute organophosphate(OP)-poisoned patients requiring invasive mechanical ventilation. Settings and d...

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Bibliographic Details
Published in:Clinical toxicology (Philadelphia, Pa.) Pa.), 2009-06, Vol.47 (5), p.419-424
Main Authors: Moses, Viju, Mahendri, Narayani V., John, George, Peter, John Victor, Ganesh, Alka
Format: Article
Language:English
Subjects:
Acute Disease
Adolescent
Adult
Atropine
Biological and medical sciences
Chemical and industrial products toxicology. Toxic occupational diseases
Cholinesterase
Critical Illness
Energy Intake
Enteral Nutrition - adverse effects
Enteral Nutrition - methods
Female
Gastroparesis - epidemiology
Gastroparesis - etiology
Hospital Mortality
Hospitals, University
Humans
Infection - epidemiology
Infection - etiology
Intensive Care Units
Length of Stay
Male
Medical sciences
Organophosphate
Organophosphate Poisoning
Prospective Studies
Respiration, Artificial
Toxicology
Treatment Outcome
Various organic compounds
Young Adult
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Summary:Introduction. Early institution of enteral feeds may be associated with improved outcomes in the critically ill. This study evaluated the effect of hypocaloric enteral nutritional supplementation in acute organophosphate(OP)-poisoned patients requiring invasive mechanical ventilation. Settings and design. Prospective randomized controlled trial conducted in the medical intensive care unit (ICU) of a tertiary care university teaching hospital. Patients and methods. During a 13-month period, 87 OP-poisoned patients were admitted. Twenty-seven patients who were not ventilated were excluded. Thirty patients were randomized to the control arm and 29 to the intervention arm. The intervention arm received hypocaloric nasogastric feeds within 48 h of intubation whilst the control arm received intravenous fluids. Primary outcome was infectious complications. Secondary outcomes included hospital mortality, duration of ventilation, ICU stay, and hospital stay. Results. An infectious complication occurred in 14 patients (48%) in the intervention group and 15 patients (50%) in the control group (p = 0.898). Three patients in each group died (p = 0.965). Duration of ventilation (p = 0.19) and ICU stay (p = 0.41) were similar. Duration of hospital stay was shorter in the control group (p = 0.05). Gastric stasis occurred in two patients (6.9%) receiving enteral feeds. Feeding related complications were less frequent than in other published trials. Conclusions. In OP-poisoned patients, early hypocaloric enteral feeding was not associated with improvements in clinical endpoints, albeit longer hospital stay was observed in the enterally fed group. Feeding related complications were infrequent. Further studies would help define the status of early enteral feeding in this subset of patients.
ISSN:1556-3650
1556-9519
DOI:10.1080/15563650902936664