Reducing costs and patient morbidity in the enterally fed intensive care unit patient.

Background: Critically ill patients are at high risk for nosocomial infections and resultant organ dysfunction and death. These patients typically have protracted intensive care unit (ICU) courses and consume increasingly limited resources. Enteral nutrition with specific immune-modulating components has been previously shown to improve outcomes in select populations of patients, but results have been mixed in critically ill patients. Impact 1.5 (Novartis Nutrition, Minneapolis, MN) is a commercially available enteral formula containing ingredients known to improve several parameters of immune function. We hypothesized that administration of Impact 1.5 tube feedings would reduce the incidence of nosocomial infection and ICU resources in critically ill patients admitted to the ICU for severe trauma, burns, or sepsis insults.

Methods: The Impact 1.5 group (n = 17) was compared with a historical cohort of ICU patients (n = 21) of similar illness severity that received a standard high-energy enteral formula. The incidence of nosocomial infections and mortality, and the consumption of multiple ICU resources were examined. A cost analysis based on these results was then performed to determine the cost effectiveness of this proprietary immunonutrition enteral formula.

Results: A pronounced reduction in nosocomial pneumonia (12% vs 52%, p < .01) was identified, with consequent trends toward a reduction in duration of mechanical ventilation and ICU length of stay. Urinary tract infections that may have less influence on ICU resources were increased in the Impact 1.5 group. No difference in mortality was identified, despite the inclusion of patients with severe sepsis in the study group. According to the average number of ICU days required for each study cohort, the Impact 1.5 group led to a cost savings of at least $193,350.00.

Conclusions: ICU patients with significant illness severity experienced a decrease in the incidence of an important nosocomial infection that is commonly associated with increased use of ICU resources and length of stay. This decrease in patient morbidity led to substantial cost savings despite the small size of our study trial.