Early versus Late Parenteral Nutrition in Critically Ill Adults

被引:1082
作者
Casaer, Michael P. [1 ]
Mesotten, Dieter [1 ]
Hermans, Greet [2 ]
Wouters, Pieter J. [1 ]
Schetz, Miet [1 ]
Meyfroidt, Geert [1 ]
Van Cromphaut, Sophie [1 ]
Ingels, Catherine [1 ]
Meersseman, Philippe [2 ]
Muller, Jan [1 ]
Vlasselaers, Dirk [1 ]
Debaveye, Yves [1 ]
Desmet, Lars [1 ]
Dubois, Jasperina [3 ,4 ]
Van Assche, Aime [3 ,4 ]
Vanderheyden, Simon [1 ]
Wilmer, Alexander [2 ]
Van den Berghe, Greet [1 ]
机构
[1] Catholic Univ Louvain, Dept Intens Care Med, Univ Hosp Leuven, B-3000 Louvain, Belgium
[2] Catholic Univ Louvain, Med Intens Care Unit, Dept Internal Med, Univ Hosp, B-3000 Louvain, Belgium
[3] Jessa Hosp, Dept Anesthesia, Hasselt, Belgium
[4] Jessa Hosp, Dept Intens Care, Hasselt, Belgium
关键词
INTENSIVE INSULIN THERAPY; ENTERAL NUTRITION; ENERGY-BALANCE; AUTOPHAGY; GUIDELINES; SUPPORT; METAANALYSIS; DEFINITIONS; MULTICENTER; INFECTIONS;
D O I
10.1056/NEJMoa1102662
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Controversy exists about the timing of the initiation of parenteral nutrition in critically ill adults in whom caloric targets cannot be met by enteral nutrition alone. Methods In this randomized, multicenter trial, we compared early initiation of parenteral nutrition (European guidelines) with late initiation (American and Canadian guidelines) in adults in the intensive care unit (ICU) to supplement insufficient enteral nutrition. In 2312 patients, parenteral nutrition was initiated within 48 hours after ICU admission (early-initiation group), whereas in 2328 patients, parenteral nutrition was not initiated before day 8 (late-initiation group). A protocol for the early initiation of enteral nutrition was applied to both groups, and insulin was infused to achieve normoglycemia. Results Patients in the late-initiation group had a relative increase of 6.3% in the likelihood of being discharged alive earlier from the ICU (hazard ratio, 1.06; 95% confidence interval [CI], 1.00 to 1.13; P = 0.04) and from the hospital (hazard ratio, 1.06; 95% CI, 1.00 to 1.13; P = 0.04), without evidence of decreased functional status at hospital discharge. Rates of death in the ICU and in the hospital and rates of survival at 90 days were similar in the two groups. Patients in the late-initiation group, as compared with the early-initiation group, had fewer ICU infections (22.8% vs. 26.2%, P = 0.008) and a lower incidence of cholestasis (P<0.001). The late-initiation group had a relative reduction of 9.7% in the proportion of patients requiring more than 2 days of mechanical ventilation (P = 0.006), a median reduction of 3 days in the duration of renal-replacement therapy (P = 0.008), and a mean reduction in health care costs of ss1,110 (about $1,600) (P = 0.04). Conclusions Late initiation of parenteral nutrition was associated with faster recovery and fewer complications, as compared with early initiation.
引用
收藏
页码:506 / 517
页数:12
相关论文
共 52 条
[1]   The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study [J].
Alberda, Cathy ;
Gramlich, Leah ;
Jones, Naomi ;
Jeejeebhoy, Khursheed ;
Day, Andrew G. ;
Dhaliwal, Rupinder ;
Heyland, Daren K. .
INTENSIVE CARE MEDICINE, 2009, 35 (10) :1728-1737
[2]   The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observational study [J].
Alberda, Cathy ;
Gramlich, Leah ;
Jones, Naomi ;
Jeejeebhoy, Khursheed ;
Day, Andrew G. ;
Dhaliwal, Rupinder ;
Heyland, Daren K. .
INTENSIVE CARE MEDICINE, 2009, 35 (10) :1728-1737
[3]  
Andersen PK, 2002, STAT METHODS MED RES, V11, P91, DOI 10.1191/0962280202SM276ra
[4]   Randomised trial of glutamine, selenium, or both, to supplement parenteral nutrition for critically ill patients [J].
Andrews, Peter J. D. ;
Avenell, Alison ;
Noble, David W. ;
Campbell, Marion K. ;
Croal, Bernard L. ;
Simpson, William G. ;
Vale, Luke D. ;
Battison, Claire G. ;
Jenkinson, David J. ;
Cook, Jonathan A. .
BMJ-BRITISH MEDICAL JOURNAL, 2011, 342 :695
[5]   Analysis and interpretation of cost data in randomised controlled trials: review of published studies [J].
Barber, JA ;
Thompson, SG .
BRITISH MEDICAL JOURNAL, 1998, 317 (7167) :1195-1200
[6]   Outcomes in critically ill patients before and after the implementation of an evidence-based nutritional management protocol [J].
Barr, J ;
Hecht, M ;
Flavin, KE ;
Khorana, A ;
Gould, MK .
CHEST, 2004, 125 (04) :1446-1457
[7]   Treating hyperglycemia improves skeletal muscle pyotein metabolism in cancer patients after major surgery [J].
Biolo, Gianni ;
De Cicco, Marcello ;
Lorenzon, Stefania ;
Dal Mas, Viviana ;
Fantin, Dario ;
Paroni, Rita ;
Barazzoni, Rocco ;
Zanetti, Michela ;
Lapichino, Gaetano ;
Guarnieri, Gianfranco .
CRITICAL CARE MEDICINE, 2008, 36 (06) :1768-1775
[8]   DEFINITIONS FOR SEPSIS AND ORGAN FAILURE AND GUIDELINES FOR THE USE OF INNOVATIVE THERAPIES IN SEPSIS [J].
BONE, RC ;
BALK, RA ;
CERRA, FB ;
DELLINGER, RP ;
FEIN, AM ;
KNAUS, WA ;
SCHEIN, RMH ;
SIBBALD, WJ .
CHEST, 1992, 101 (06) :1644-1655
[9]  
Braunschweig CL, 2001, AM J CLIN NUTR, V74, P534
[10]   Nutrition therapy in the critical care setting: What is "best achievable" practice? An international multicenter observational study [J].
Cahill, Naomi E. ;
Dhaliwal, Rupinder ;
Day, Andrew G. ;
Jiang, Xuran ;
Heyland, Daren K. .
CRITICAL CARE MEDICINE, 2010, 38 (02) :395-401