BackgroundThe optimal dose and timing of enteral nutrition (EN) in septic shock are unclear.MethodsWe conducted a phase 3 single‐center randomized controlled pilot trial comparing early trophic EN with “no EN” in mechanically ventilated adults with septic shock, with the hypothesis that implementing a protocol comparing early trophic EN with “no EN” in patients with septic shock would be feasible. Patients were randomized to early trophic EN or “no EN” until off vasopressor for 3 hours. The primary outcome was feasibility in achieving >75% consent and compliance rate and <10% contamination rate.ResultsOne hundred thirty‐one patients were eligible for enrollment, and 49 were available for consent. Thirty‐one (86%) consented and were randomized and 100% of patients in the early EN arm and 94% in the “no EN” arm completed their protocols. While on vasopressors, early EN group received median 384 kcal, and the “no EN” group received median 0 kcal. Contamination rate was 0 in the early trophic EN arm and 6% in the “no EN” arm. The early EN group had median 25 intensive care unit–free days, as compared with 12 in the “no EN” arm (P = .014). The early EN arm had median 27 ventilator‐free days, compared with 14 in “no EN” arm (P = .009).ConclusionOur protocol comparing early trophic EN with “no EN” in septic shock was feasible. Early trophic EN may be beneficial, but a larger multicenter trial is warranted to confirm the observed clinical benefits seen in this trial.
Prasugrel may be considered a therapeutic alternative in some patients allergic or intolerant to clopidogrel, but additional data are warranted to make a strong conclusion.
Among patients receiving alteplase for presumed or confirmed PE during cardiac arrest, the most common treatment was administration of a single 50-mg bolus of the thrombolytic agent. This treatment was received by all survivors of cardiac arrest.
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