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Excerpt
Introduction: Case reports and prospective cohort studies suggest that bacterial contamination of the enteral nutrition delivery system(ENS) is a cause of morbidity and mortality in the critically ill patient. As bacterial growth and replication is pH dependent, we hypothesized that acidified enteral feeds would lower the incidence of bacterial contamination of ENS and potentially infectious morbidity and mortality of critically ill patients. We conducted a randomized, double-blind, placebo-controlled, multicenter study to evaluate the effect of acidified enteral feeds on bacterial growth in the ENS and subsequent colonization and infection.
Methods: We recruited mechanically ventilated critically ill patients expected to remain ventilated > 48 hours. We excluded patients with overt gastrointestinal bleeding, persistent acidemia, and renal failure requiring dialysis. We enrolled 120 patients: female(38%), age 57.6(+/- 19.3), and mean APACHE II Score was 21.6(+/- 7.6). Vital HN was used as the standard feeding formula for the control group. Hydrochloric acid was added to achieve a pH to 3.5 in the experimental group. We measured contamination of ENS, gastric colonization, and pneumonia.
Results: Patients who received acid feeds were less likely to have potentially pathogenic microorganisms in their ENS(19% vs. 80% patients, p < 0.001, and 0.1 organisms/specimen vs. 0.8 organisms/specimen in the control group, p < 0.001). One patient (2%) on acid feeds was colonized in the stomach with pathogens and 3 (6.1%) developed pneumonia. In the control group, 20 patients(43%) were colonized in the stomach with pathogens (p < 0.001) and 7(15%) developed pneumonia (p=0.19). Overall, there were 7 deaths in the control group and 15 in the acid feeds group (p=0.10) while only 3 patients in the control group and 4 in the acid feeds group died during the study period (p=NS).
Conclusions: Acidified enteral feeds reduces contamination of the feeding system and subsequent colonization in critically ill patients. Larger studies are needed to examine its effect on ventilator associated pneumonia and mortality.
