Early versus On-Demand Nasoenteric Tube Feeding in Acute Pancreatitis

被引：329

作者：

Bakker, O. J. ^{[1
]}

van Brunschot, S. ^{[2
]}

van Santvoort, H. C. ^{[1
]}

Besselink, M. G. ^{[3
]}

Bollen, T. L. ^{[6
]}

Boermeester, M. A. ^{[3
]}

Dejong, C. H. ^{[9
,10
]}

van Goor, H. ^{[11
]}

Bosscha, K. ^{[14
]}

Ali, U. Ahmed ^{[1
]}

Bouwense, S. ^{[11
]}

van Grevenstein, W. M. ^{[1
]}

Heisterkamp, J. ^{[15
]}

Houdijk, A. P. ^{[16
]}

Jansen, J. M. ^{[5
]}

Karsten, T. M. ^{[17
]}

Manusama, E. R. ^{[18
]}

Nieuwenhuijs, V. B. ^{[19
]}

Schaapherder, A. F. ^{[20
]}

van der Schelling, G. P. ^{[21
]}

Schwartz, M. P. ^{[22
]}

Spanier, B. W. M. ^{[23
]}

Tan, A. ^{[13
]}

Vecht, J. ^{[24
]}

Weusten, B. L. ^{[7
]}

Witteman, B. J. ^{[25
]}

Akkermans, L. M. ^{[1
]}

Bruno, M. J. ^{[26
]}

Dijkgraaf, M. G. ^{[4
]}

van Ramshorst, B. ^{[8
]}

Gooszen, H. G. ^{[12
]}

机构：

[1] Univ Med Ctr Utrecht, Dept Surg, NL-3508 GA Utrecht, Netherlands

[2] Amsterdam Med Ctr, Dept Gastroenterol & Hepatol, Amsterdam, Netherlands

[3] Amsterdam Med Ctr, Dept Surg, Amsterdam, Netherlands

[4] Amsterdam Med Ctr, Clin Res Unit, Amsterdam, Netherlands

[5] Onze Lieve Vrouw Hosp, Dept Gastroenterol, Amsterdam, Netherlands

[6] St Antonius Hosp, Dept Radiol, Nieuwegein, Netherlands

[7] St Antonius Hosp, Dept Gastroenterol, Nieuwegein, Netherlands

[8] St Antonius Hosp, Dept Surg, Nieuwegein, Netherlands

[9] Maastricht Univ, Med Ctr, Dept Surg, Maastricht, Netherlands

[10] NUTRIM Sch Nutr Toxicol & Metab, Maastricht, Netherlands

[11] Radboud Univ Nijmegen, Med Ctr, Dept Surg, NL-6525 ED Nijmegen, Netherlands

[12] Radboud Univ Nijmegen, Med Ctr, Dept Operat Room Evidence Based Surg, NL-6525 ED Nijmegen, Netherlands

[13] Canisius Wilhelmina Hosp, Dept Gastroenterol, Nijmegen, Netherlands

[14] Jeroen Bosch Hosp, Dept Surg, sHertogenbosch, Netherlands

[15] St Elizabeth Hosp, Dept Surg, Tilburg, Netherlands

[16] Med Ctr Alkmaar, Dept Surg, Alkmaar, Netherlands

[17] Reinier de Graaf Gasthuis, Dept Surg, Delft, Netherlands

[18] Med Ctr Leeuwarden, Dept Surg, Leeuwarden, Netherlands

[19] Univ Groningen, Univ Med Ctr Groningen, Dept Surg, NL-9713 AV Groningen, Netherlands

[20] Leiden Univ, Dept Surg, Med Ctr, Leiden, Netherlands

[21] Amphia Hosp, Dept Surg, Breda, Netherlands

[22] Meander Med Ctr, Dept Gastroenterol, Amersfoort, Netherlands

[23] Rijnstate Hosp, Dept Gastroenterol, Arnhem, Netherlands

[24] Isala Clin, Dept Gastroenterol, Zwolle, Netherlands

[25] Hosp Gelderse Vallei Ede, Dept Gastroenterol, Ede, Netherlands

[26] Erasmus Univ, Med Ctr, Dept Gastroenterol & Hepatol, Rotterdam, Netherlands

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2014年 / 371卷 / 21期

关键词：

EARLY ENTERAL NUTRITION; CRITICALLY-ILL PATIENT; SMALL-BOWEL MOTILITY; NECROTIZING PANCREATITIS; INTERNATIONAL CONSENSUS; BACTERIAL TRANSLOCATION; PRACTICE GUIDELINES; ESPEN GUIDELINES; CONTROLLED-TRIAL; ORGAN FAILURE;

D O I：

10.1056/NEJMoa1404393

中图分类号：

R5 [内科学];

学科分类号：

100201 [内科学];

摘要：

BACKGROUND Early enteral feeding through a nasoenteric feeding tube is often used in patients with severe acute pancreatitis to prevent gut-derived infections, but evidence to support this strategy is limited. We conducted a multicenter, randomized trial comparing early nasoenteric tube feeding with an oral diet at 72 hours after presentation to the emergency department in patients with acute pancreatitis. METHODS We enrolled patients with acute pancreatitis who were at high risk for complications on the basis of an Acute Physiology and Chronic Health Evaluation II score of 8 or higher (on a scale of 0 to 71, with higher scores indicating more severe disease), an Imrie or modified Glasgow score of 3 or higher (on a scale of 0 to 8, with higher scores indicating more severe disease), or a serum C-reactive protein level of more than 150 mg per liter. Patients were randomly assigned to nasoenteric tube feeding within 24 hours after randomization (early group) or to an oral diet initiated 72 hours after presentation (on-demand group), with tube feeding provided if the oral diet was not tolerated. The primary end point was a composite of major infection (infected pancreatic necrosis, bacteremia, or pneumonia) or death during 6 months of follow-up. RESULTS A total of 208 patients were enrolled at 19 Dutch hospitals. The primary end point occurred in 30 of 101 patients (30%) in the early group and in 28 of 104 (27%) in the on-demand group (risk ratio, 1.07; 95% confidence interval, 0.79 to 1.44; P = 0.76). There were no significant differences between the early group and the on-demand group in the rate of major infection (25% and 26%, respectively; P = 0.87) or death (11% and 7%, respectively; P = 0.33). In the on-demand group, 72 patients (69%) tolerated an oral diet and did not require tube feeding. CONCLUSIONS This trial did not show the superiority of early nasoenteric tube feeding, as compared with an oral diet after 72 hours, in reducing the rate of infection or death in patients with acute pancreatitis at high risk for complications.

引用

页码：1983 / 1993

页数：11

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