Feeding Practices and Extubation Outcomes in Critically Ill Cardiac Patients: Insights from a High-Turnover ICU

Abstract

Objectives: Cardiovascular diseases (CVD) remain a leading cause of morbidity and mortality in Pakistan, with a substantial proportion of patients requiring mechanical ventilation in resource-limited intensive care units (ICUs). Optimizing extubation strategies is essential for improving patient outcomes and alleviating pressure on overburdened ICU systems. This study investigates the impact of continuous enteral feeding compared to fasting prior to extubation on rates of extubation failure, ICU-related complications, and mortality in critically ill CVD patients. Methodology: A prospective cross-sectional study was conducted at the National Institute of Cardiovascular Diseases, Karachi, from August 2023 to January 2024. A total of 309 intubated adult CVD patients were included. Patients were categorized into three groups based on feeding protocols: continuous feeding, interrupted feeding, and fasting before extubation. The primary outcome was extubation failure, defined as the need for re-intubation within 48–72 hours post-extubation. Secondary outcomes included ICU complications, duration of ICU stay, and mortality. Results: Of the 309 patients (mean age: 58.9 years; 61.2% male), 42.7% were fasting, 29.1% received continuous feeding, and 28.2% underwent interrupted feeding prior to extubation. The overall re-intubation rate within 48 hours was 2.6%, with no statistically significant differences among the continuous (4.4%), interrupted (1.1%), and fasting (2.3%) groups (p = 0.369). Similarly, ICU mortality did not significantly differ between groups (p = 0.383). Higher body mass index (BMI) emerged as an independent predictor of extubation failure (OR 1.13, p = 0.023). Conclusion: There were no significant differences in extubation failure, ICU mortality, or complications between the continuous, interrupted, and fasting feeding groups. Continuous feeding may help avoid unnecessary delays in extubation, particularly in resource-constrained ICUs, supporting a flexible and individualized approach to feeding strategies.