Abstract
Early enteral nutrition after admission is recommended for critically ill patients. Hyperglycemia is considered to be associated with the mortality and morbidity of critically ill individuals. We employed a high-fat low-carbohydrate enteral formula, reported to be useful for controlling blood glucose in diabetes, for patients admitted to our trauma and critical care center from April 2010 instead of the standard enteral formula. The aim of this study was to clarify the effect on glycemic control of this high-fat low-carbohydrate enteral formula in comparison with the standard enteral formula. A total of 147 mechanically ventilated patients hospitalized between April 2009 and March 2011 were enrolled in this study. Among them, 74 patients hospitalized between April 2009 and March 2010 received the standard enteral formula (Group S), while 73 patients hospitalized between April 2010 and March 2011 received the high-fat low-carbohydrate enteral formula (Group G). Enteral feeding was started within 7 days after admission. Each formula was given continuously starting at a rate of 20 ml/hr, which was increased to provide an appropriate caloric intake within a few days of starting nutritional support. We measured the maximum blood glucose level and need for insulin therapy after starting enteral nutrition in both groups. There were no significant differences between the two groups with regard to age, sex, underlying diseases, and blood glucose at the start of feeding. The maximum blood glucose level of group S (163±32.0 mg/dl) was significantly higher than that of group G (151±28.4 mg/dl) (p=0.022). The rate of starting insulin therapy was significantly higher in group S (12.2%) than in group G (1.37%) (p=0.018). No differences were observed between the two groups with regard to mortality, intensive care unit stay, and gastrointestinal morbidity. In conclusion, a high-fat low-carbohydrate enteral formula is more effective for glycemic control in critically ill patients compared with a standard enteral formula.
