Continuation of enteral nutrition in critically ill patients with nonclinically important nonvariceal upper gastrointestinal bleeding: A retrospective cohort study

BACKGROUND: Enteral nutrition (EN) is the preferred method of nutrition support for critically ill patients, but its continuation during nonclinically important nonvariceal upper gastrointestinal bleeding (NVUGIB) remains controversial. METHODS: This retrospective cohort study was conducted in patients in an intensive care unit (ICU) who developed nonclinically important NVUGIB while receiving EN. Patients were categorized into two groups: continued EN group and suspended EN group after the bleeding episode. The primary outcome was progression to clinically important GIB. Secondary outcomes included mortality and being mechanical ventilation free at 28 days. Propensity score matching (PSM) was performed to account for potential confounding variables. RESULTS: Among 590 eligible patients, 400 (67.8%) continued EN and 190 (32.2%) had EN suspended. Progression to clinically important GIB was similar between groups (6.0% vs 6.3%, P = 0.88), a finding confirmed after PSM (7.3% vs 7.3%, P > 0.99). Patients continuing EN had more ventilation-free days (9 vs 6 days, P < 0.001; matched: 10 vs 6 days, P = 0.005). Unmatched analysis showed higher in-hospital mortality in the suspension group (45.5% vs 54.7%, P = 0.036), but this was nonsignificant post-PSM (53.3% vs 46.7%, P = 0.12). Continuation of EN was not found to be significantly associated with clinically important GIB (odds ratio = 1.913, P = 0.30). CONCLUSION: Continuing EN in critically ill patients with nonclinically important NVUGIB appears to be safe and may be associated with a reduced duration of mechanical ventilation. These findings suggest that EN can be safely continued in patients with nonclinically important NVUGIB, potentially offering benefits in terms of respiratory outcomes and nutrition support.