A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Harvey, Sheila; Parrott, Francesca; Harrison, David A; Sadique, Zia; Grieve, Richard; Canter, Ruth R; McLennan, Blair Kp; Tan, Jermaine Ck; Bear, Danielle E.; Segaran, Ella; Beale, Richard; Bellingan, Geoff; Leonard, Richard C.; Mythen, Michael G.; Rowan, Kathy

doi:10.3310/hta20280

Cited by 66 publications

(64 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This finding was replicated in a recent multicenter RCT that included an integrated economic evaluation conducted in the UK [98] . The additional finding from this study was that parenteral nutrition had greater costs than Among other nutritional recommendations, the SSC 2016 guidelines [17] recommend against parenteral nutrition (alone or in combination with enteral feeding) in patients with sepsis or septic shock within the first 7 days.…”

Section: Nutritionmentioning

confidence: 65%

Update of Sepsis in the Intensive Care Unit

Genga¹,

Russell²

2017

J Innate Immun

110

View full text Add to dashboard Cite

Sepsis, the most common cause of admission to an intensive care unit (ICU), has had an increased incidence and prevalence over the last years with a simultaneous decrease in its short-term mortality. Sepsis survivors are more frequently discharged from hospital and often experience long-term outcomes such as late mortality, immune dysfunction, secondary infections, impaired quality of life, and unplanned readmissions. Early recognition and management of sepsis have challenged emergency care and critical care physicians and nurses. New sepsis definitions were produced and the Surviving Sepsis Campaign (SSC) 2016 was updated recently. Although hospital readmissions after sepsis are common, associated risk factors and how to manage patients who survive an episode of sepsis still need clarification. The immune dysfunction caused by sepsis/septic shock is complex, persistent, affects inflammatory and anti-inflammatory systems, and might be associated with long-term outcomes of sepsis. Several randomized controlled trials (RCT) that analyzed new (and old) interventions in sepsis/septic shock are discussed in this review in parallel with the SSC 2016 recommendations and other guidelines when relevant. RCTs addressing incidence, treatment, and prevention of important sepsis-associated organ dysfunction such as the acute respiratory distress syndrome, acute kidney injury, and brain dysfunction are highlighted. Finally, we briefly discuss the need for novel targets, predictive biomarkers, and new designs of RCTs in sepsis.

show abstract

Section: Nutritionmentioning

confidence: 65%

Update of Sepsis in the Intensive Care Unit

Genga¹,

Russell²

2017

J Innate Immun

110

View full text Add to dashboard Cite

show abstract

“…This is a recommended measure of HRQoL in critical care 45 and it has been used in critical care trials. [46][47][48] Until recently, the EQ-5D-3L has been commonly used, in which each dimension in the descriptive system is assessed using three levels of severity. In order to reduce ceiling effects (the proportion of respondents reporting the best possible health) and to increase sensitivity to changes and differences in health status, the EQ-5D-5L was developed.…”

Section: Background and Aimsmentioning

confidence: 99%

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

Walsh

Stanworth

Boyd

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

on behalf of the UK ABLE trial investigatorsThe Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost-utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up The full HTA archive is freely available to view online at www.journalslibrary.nihr.ac.uk/hta. Print-on-demand copies can be purchased from the report pages of the NIHR Journals Library website: www.journalslibrary.nihr.ac.uk Criteria for inclusion in the Health Technology Assessment journalReports are published in Health Technology Assessment (HTA) if (1) they have resulted from work for the HTA programme, and (2) they are of a sufficiently high scientific quality as assessed by the reviewers and editors.Reviews in Health Technology Assessment are termed 'systematic' when the account of the search appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others. HTA programmeThe HTA programme, part of the National Institute for Health Research (NIHR), was set up in 1993. It produces high-quality research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS. 'Health technologies' are broadly defined as all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care.The journal is indexed in NHS Evidence via its abstracts included in MEDLINE and its Technology Assessment Reports inform National Institute for Health and Care Excellence (NICE) guidance. HTA research is also an important source of evidence for National Screening Committee (NSC) policy decisions.For more information about the HTA programme please visit the website: http://www.nets.nihr.ac.uk/programmes/hta This reportThe research reported in this issue of the journal was funded by the HTA programme as project number 09/144/51. The contractual start date was in September 2011. The draft report began editorial review in September 2016 and was accepted for publication in April 2017. The authors have been wholly responsible for all data collection, analysis and interpretation, and for writing up their work. The HTA editors and publisher have tried to ensure the accuracy of the authors' report and would like to thank the reviewers for their constructive comments on the draft document. However, they do not accept liability for damages or losses arising from material published in this report.This report presents independent research funded by the National Institute for Health Research (NIHR). The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the NHS, the NIHR, NETSCC, the HTA programme or the Department of Health. If there are verbatim quotations included in this publication the views and opinions expressed by the interviewees are those of the int...

show abstract

“…Estudos demonstram que a via enteral é a modalidade preferencial de TN, considerando os menores custos e riscos de complicações (Gramlich et al, 2004;Tamiya et al, 2015;Harvey et al, 2016). Isso justifica o maior núme-ro de contas (269 versus 91 contas) e o maior custo total em dieta enteral, encontrado neste estudo.…”

Section: Discussionunclassified

“…Ou seja, foi observado que poucos prestadores foram responsáveis pela maior parte dos custos em dieta. Considerando que a TN preferencial é a via enteral, em razão dos menores custos e riscos de complicações, esperava-se uma maior representatividade nos custos com essa modalidade de dieta em todos os serviços (Gramlich et al, 2004;Tamiya et al, 2015;Harvey et al, 2016). Entretanto, observou-se que um dos prestadores apresentou um custo maior com dieta parenteral em relação à dieta enteral (66,37% versus 33,63%).…”

Section: Discussionunclassified

“…Já a nutrição parenteral tem por objetivo suprir os nutrientes do paciente através de uma via venosa, nas situações de impossibilidade de fornecimento de dieta pelo trato gastrointestinal, seja por obstrução, dificuldade de absorção ou digestão adequada do alimento (White et al, 2012;Acuna & Cruz, 2004). Habitualmente, a nutrição enteral é preferencialmente utilizada em razão do menor custo e menor risco de complicações (principalmente infecção) (Gramlich et al, 2004;Tamiya et al, 2015;Harvey et al, 2016).…”

Section: Introductionunclassified

See 1 more Smart Citation

Impacto da terapia nutricional no custo total das contas hospitalares

Hyeda¹,

Costa²

2017

JBES

View full text Add to dashboard Cite

RESUMOObjetivo: Avaliar o impacto da terapia nutricional no custo total das contas hospitalares de indiví-duos que utilizaram dieta enteral ou parenteral. Métodos: Trata-se de um estudo transversal, documental, retrospectivo, com estratégia qualitativa e quantitativa, a partir da análise de contas hospitalares. Resultados: Foram analisadas 301 contas hospitalares de 159 indivíduos. Houve 208 contas apenas com dieta enteral, 32 apenas com dieta parenteral e 61 com dieta enteral e parenteral (uso concomitante ou não). O custo total em dieta foi de 35,4% do valor total das contas hospitalares. O custo com dieta enteral foi de 59,8% do custo total em dieta. O custo com dieta parenteral por indivíduo foi 2,2 vezes maior do que a dieta enteral. Entre os 10 serviços de saúde estudados, apenas quatro foram responsáveis por 88,3% das contas hospitalares e 93,0% do custo total em dieta. A maioria deles apresentou um maior custo total com dieta enteral. A relação entre o custo com dieta e o custo total das contas hospitalares variou entre os serviços de 2,4 a 44,4%. Conclusão: A terapia nutricional apresentou um percentual importante do custo total das contas hospitalares, principalmente devido à dieta enteral. A análise do custo total e do custo por dia de internação em dieta permitiu identificar o perfil de utilização de terapia nutricional em cada serviço de saúde, informação importante na gestão de custos em dieta. ABSTRACT Objective:To evaluate the impact of nutritional therapy on the total cost of hospital accounts in patients who used enteral or parenteral diet. Methods: This is a retrospective, cross-sectional, documental study with a qualitative and quantitative design, based on analysis of hospital accounts. Results: We analyzed 301 hospital accounts of 159 individuals. There were 208 accounts with enteral diet, 32 accounts with parenteral diet and 61 accounts with enteral and parenteral diet (concomitant use or not). The total cost in diet was 35.4% of the total cost of accounts. The cost in enteral diet was 59.8% of the total cost in diet. The cost in enteral diet was 59.8% of the total cost in diet. The cost in parenteral diets per patient was 2.2 times higher than the costs of enteral diet. Among the 10 health services studied, only four of them accounted for 88.3% of the hospital expenses and 93.0% of the total cost in diet. Most of them had a higher total cost with enteral diet. The relationship between diet cost and total cost of the hospital accounts varied of 2.4 to 44.4% in the health services. Conclusion: Nutritional therapy had a significant percentage of the total costs mainly due to the enteral diet. The analysis of the total cost in diet and the cost per day in hospitalization allowed identifying the profile of the use of nutritional therapy in each health service and this is an important information to the management of costs in diet.

show abstract

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES)

Cited by 66 publications

References 64 publications

Update of Sepsis in the Intensive Care Unit

Update of Sepsis in the Intensive Care Unit

The Age of BLood Evaluation (ABLE) randomised controlled trial: description of the UK-funded arm of the international trial, the UK cost–utility analysis and secondary analyses exploring factors associated with health-related quality of life and health-care costs during the 12-month follow-up

Impacto da terapia nutricional no custo total das contas hospitalares

Contact Info

Product

Resources

About