Fig 1.
Before EN initiation, Hemodynamic should be stabilized with MAP>65 mmHg and lactate<4 mmol/l, or vasopressor dose was decreasing. GI function was then evaluated with the AGI staging system. For pateints with AGI of I, EN could be started at 25 ml/h. For patients with AGI II-III, predigested EN could be started at 10–15 ml/h. EN was withheld for those with AGI IV. If patients were at high risk of malnutrition, parenteral nutrition (PN) should started.
Table 1.
Enteral nutrition tolerance score.
Fig 2.
Protocols for the management of adverse events.
EN was discontinued if persistent abdominal pain occurred. Physical examination and abdominal computed tomography would be ordered. If there was bowel obstruction or ischemia, EN would be discontinued. Diarrhea could be caused by enteral feeding, specific diseases and drugs. If clostridium difficile (CD) infection was identified, the patient should be treated with metronidazole or vancomycin. If the patient experienced vomiting and/or abdominal distension, bed head should be elevated to 30 to 40 degrees with administration of metoclopramide.
Fig 3.
Subject enrollment in each participating center over the study period.
Fig 4.
Missing pattern of some important variables.
Table 2.
Comparisons of baseline characteristics of subjects enrolled in the two stages (continuous variables).
Table 3.
Comparisons of baseline characteristics of subjects enrolled in the two stages (categorical variables).
Table 4.
Comparisons of outcome variables of stage one versus stage two.
Fig 5.
Comparisons of EN proportion between stage 1 and 2.
Patients in stage 2 received more EN than that in stage 1. The proportion of EN increased from day 1 to day 7.
Table 5.
Comparisons of the percentage (%) of estimated energy goal reached from day 1 to day 7.
Fig 6.
Visualization of the interaction between age and stage.
EN feeding protocol tended to benefit younger patients, and was less likely to benefit old ones.
Table 6.
Multivariable Logistic regression model showing independent predictors of 28-day mortalit.