Background: Early enteral nutrition (EN) initiation is recommended for intensive care unit (ICU) patients; however, the optimal rate of EN advancement remains unclear. We aimed to assess the association between EN advancement and in‐hospital mortality, as well as length of hospital stay.Methods: We performed a retrospective cohort study on 341 critically ill adults receiving EN between January 2021 and December 2023. The exposure of interest was rapid EN advancement, defined as an EN change exceeding the median value calculated between the first and seventh days after EN initiation. The comparator group included patients without rapid EN advancement. Factors related to in‐hospital mortality and length of hospital stay were assessed using multivariable logistic and linear regression analyses. Subgroup analyses were performed for EN initiation within 48 h of ICU admission.Results: Rapid EN advancement reduced in‐hospital mortality (adjusted odds ratio [OR] = 0.64, 95% CI 0.38–1.07, P = 0.092), although this was not statistically significant. However, rapid EN advancement significantly shortened hospital stay by 25 days (95% CI −25 to −9.2, P = 0.002). In the early EN initiation subgroup, rapid EN advancement significantly reduced in‐hospital mortality (adjusted OR = 0.42, P = 0.039) and shortened hospital stay by 48 days (95% CI −77 to −19, P = 0.001).Conclusion: Rapid EN advancement reduced in‐hospital mortality and length of hospital stay in critically ill patients, especially with early EN initiation. These findings could inform clinical practices that enhance timely and adequate nutrition therapy in ICUs. Further randomized controlled trials can help establish clinical guidelines.

Im C, et al. Ann Surg Treat Res. 2023 Feb;104(2):80-89. https://doi.org/10.4174/astr.2023.104.2.80

Shin HK, et al. J Korean Med Sci. 2027 Feb;42:e33. https://doi.org/10.3346/jkms.2027.42.e33

Background/Objectives: Early enteral nutrition (EN) initiation and progressive EN advancement are critical components of nutritional care in critically ill patients; however, not all patients achieve successful early EN advancement in real-world intensive care unit (ICU) settings. We investigated clinical predictors of early EN initiation and successful early EN advancement at ICU admission in a retrospective cohort study at a single tertiary academic medical center in South Korea. Methods: A total of 2112 critically ill adults receiving EN between January 2020 and December 2024 were included. Successful early EN advancement was defined as EN initiation within 48 h of ICU admission, followed by progressive advancement without any reduction or discontinuation during the subsequent seven days. Using a two-stage multivariable logistic regression approach, we identified predictors of each outcome. Results: Among the total cohort, 722 patients (34.2%) achieved early EN initiation, of whom 449 (62.2%) subsequently achieved successful early EN advancement, representing 21.3% of the total cohort. Male sex (adjusted odds ratio [aOR] 0.87, 95% CI 0.78–0.96), higher admission lactate (aOR 0.85, 95% CI 0.74–0.96), prior surgery (aOR 0.81, 95% CI 0.70–0.93), and higher APACHE II score (aOR 0.88, 95% CI 0.79–0.99) were identified as significant negative predictors (all p < 0.05). Admission-time variables (male sex, elevated lactate, prior surgery, and higher APACHE II scores) effectively identify patients at risk of early EN failure. Conclusions: Reflecting distinct predictor profiles between ICU types, the preliminary nomogram can guide tailored nutritional strategies, although prospective external validation remains essential before clinical implementation.

Purpose: Managing hemodynamically unstable patients with pelvic fractures is highly challenging, particularly when vascular injuries are present, as these can significantly worsen prognosis. This study evaluated outcomes in patients with pelvic trauma and vascular injuries prior to the introduction of preperitoneal pelvic packing.Methods: We retrospectively reviewed the medical records of 195 patients with pelvic injuries who presented to the emergency room of our hospital between May 2003 and August 2013.Results: Among the 195 patients, 34 had vascular injuries and 161 had nonvascular injuries. The vascular injury group had significantly higher transfusion rates (82.4% vs. 11.8%, P<0.001) and required a greater mean number of packed red blood cell units than the nonvascular group (5.2±5.5 vs. 0.4±1.4, P<0.001). Subgroup analysis within the vascular injury cohort revealed significant differences between patients with venous phase extravasation (n=5) and those with isolated arterial phase extravasation (n=29) in median packed red blood cell units transfused (12.5 units vs. 3 units; P=0.014), cardiac arrest rate (80.0% vs. 10.3%, P=0.003), and mortality rate (60.0% vs. 10.3%, P=0.029). Notably, patients with isolated venous extravasation showed a significantly higher mortality rate compared to those with isolated arterial extravasation (100% vs. 10.3%, P=0.004).Conclusions: Venous phase extravasation was associated with higher transfusion requirements, cardiac arrest incidence, and mortality compared to arterial extravasation.

Environmental Health Perspectives is an Open Access journal published by the National Institute of Environmental Health Sciences. Environmental Health Perspectives is an Open Access journal published by the National Institute of Environmental Health Sciences.