A prospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered?

Jonghe, Bernard De; Appere-De-Vechi, Corinne; Fournier, Muriel; Tran, Beatrice; Merrer, Jacques; Melchior, Jean‐Claude; Outin, Hervé

doi:10.1097/00003246-200101000-00002

Cited by 354 publications

(278 citation statements)

References 20 publications

Supporting

Mentioning

241

Contrasting

Unclassified

Order By: Relevance

“…In both groups, a majority of patients did not reach caloric targets. Although enteral feeding is commonly associated with a failure to reach nutritional targets, 7,8 there is a widespread assumption that the parenteral route should be more reliable in guaranteeing delivery. 61,62 Although we do not know exactly why target was not achieved in those fed via the parenteral route, we do know that participation in the CALORIES trial required units to deliver nutritional support via the parenteral route to more patients than would be their usual practice.…”

Section: Discussionmentioning

confidence: 99%

Section: Background and Rationalementioning

confidence: 99%

“…7,8 In contrast, the parenteral route though more invasive and expensive is more likely to secure delivery of the intended nutrition. 7 Historically, nutritional support via the parenteral route has been associated with more risks and complications (e.g. infectious complications) compared with the enteral route 2-4 but recent improvements in the delivery, formulation and monitoring of PN justify further comparison and evaluation of these routes of nutritional support, particularly in the early phase of the illness.…”

Section: Background and Rationalementioning

confidence: 99%

See 2 more Smart Citations

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

Parrott

Harrison

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

BackgroundMalnutrition is a common problem in critically ill patients in UK NHS critical care units. Early nutritional support is therefore recommended to address deficiencies in nutritional state and related disorders in metabolism. However, evidence is conflicting regarding the optimum route (parenteral or enteral) of delivery.ObjectivesTo estimate the effect of early nutritional support via the parenteral route compared with the enteral route on mortality at 30 days and on incremental cost-effectiveness at 1 year. Secondary objectives were to compare the route of early nutritional support on duration of organ support; infectious and non-infectious complications; critical care unit and acute hospital length of stay; all-cause mortality at critical care unit and acute hospital discharge, at 90 days and 1 year; survival to 90 days and 1 year; nutritional and health-related quality of life, resource use and costs at 90 days and 1 year; and estimated lifetime incremental cost-effectiveness.DesignA pragmatic, open, multicentre, parallel-group randomised controlled trial with an integrated economic evaluation.SettingAdult general critical care units in 33 NHS hospitals in England.Participants2400 eligible patients.InterventionsFive days of early nutritional support delivered via the parenteral (n = 1200) and enteral (n = 1200) route.Main outcome measuresAll-cause mortality at 30 days after randomisation and incremental net benefit (INB) (at £20,000 per quality-adjusted life-year) at 1 year.ResultsBy 30 days, 393 of 1188 (33.1%) patients assigned to receive early nutritional support via the parenteral route and 409 of 1195 (34.2%) assigned to the enteral route had died [p = 0.57; absolute risk reduction 1.15%, 95% confidence interval (CI) −2.65 to 4.94; relative risk 0.97 (0.86 to 1.08)]. At 1 year, INB for the parenteral route compared with the enteral route was negative at −£1320 (95% CI −£3709 to £1069). The probability that early nutritional support via the parenteral route is more cost-effective – given the data – is < 20%. The proportion of patients in the parenteral group who experienced episodes of hypoglycaemia (p = 0.006) and of vomiting (p < 0.001) was significantly lower than in the enteral group. There were no significant differences in the 15 other secondary outcomes and no significant interactions with pre-specified subgroups.LimitationsBlinding of nutritional support was deemed to be impractical and, although the primary outcome was objective, some secondary outcomes, although defined and objectively assessed, may have been more vulnerable to observer bias.ConclusionsThere was no significant difference in all-cause mortality at 30 days for early nutritional support via the parenteral route compared with the enteral route among adults admitted to critical care units in England. On average, costs were higher for the parenteral route, which, combined with similar survival and quality of life, resulted in negative INBs at 1 year.Future workNutritional support is a complex combination of timing, dose, duration, delivery and type, all of which may affect outcomes and costs. Conflicting evidence remains regarding optimum provision to critically ill patients. There is a need to utilise rigorous consensus methods to establish future priorities for basic and clinical research in this area.Trial registrationCurrent Controlled Trials ISRCTN17386141.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 28. See the NIHR Journals Library website for further project information.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Background and Rationalementioning

confidence: 99%

Section: Background and Rationalementioning

confidence: 99%

See 1 more Smart Citation

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

Parrott

Harrison

et al. 2016

Health Technol Assess

View full text Add to dashboard Cite

show abstract

“…Several studies have examined practices related to EN in the ICU and found that inadequate nutrition support is common. 23,24 Delay in providing adequate nutrition support 72 hours after an acute illness may lead to many unwanted consequences. Underfeeding may reduce the integrity of the gastrointestinal tract, and maintenance of immunity and the stress response to injury.…”

Section: Timing Of Nutrition Supportmentioning

confidence: 99%

Evidence-based Nutritional Support in the Intensive Care Unit

Elamin

Camporesi

2009

International Anesthesiology Clinics

View full text Add to dashboard Cite

“…A tolerância à nutrição enteral deve ser cuidadosamente monitorada. Distensão e dor abdominal, resíduo gástrico e vômitos limitam a progressão do suporte nutricional [14][15][16][17] . Além disso, o adequado suprimento de vitaminas e minerais, estabelecido a partir de estimativas derivadas de estudos de base populacional, deve ser assegurado [18][19][20][21][22] .…”

Section: N T R O D U ç ã Ounclassified

Suprimento de micronutrientes, adequação energética e progressão da dieta enteral em adultos hospitalizados

et al. 2008

View full text Add to dashboard Cite

ObjetivoAvaliar a adequação da dieta enteral, em termos de micronutrientes e energia e identificar fatores interferentes na progressão da dieta enteral prescrita a adultos hospitalizados em um hospital geral de alta complexidade. MétodosEntre junho de 2004 e maio de 2005, adultos internados em um hospital de alta complexidade do sul do Brasil foram avaliados quanto às suas características clínicas e da prescrição da nutrição enteral. As características da nutrição enteral foram avaliadas e comparadas às recomendações diárias de ingestão, obtendo-se o percentual de adequação de nutrientes prescritos na dieta enteral em relação aos valores de recomendação para cada paciente. Os fatores associados à prescrição de energia foram identificados por meio de Regressão Linear Múltipla. ResultadosForam acompanhados 230 pacientes em uso de nutrição enteral. As recomendações diárias foram alcançadas satisfatoriamente para vitaminas hidrossolúveis (exceto ácido fólico), lipossolúveis (exceto vitamina D) e minerais (exceto cálcio). Em média, as prescrições iniciais de nutrição enteral ofereceram 24,0kcal/kg/dia (desvio-padrão=10,8, e valores mínimo e máximo de 4,3 a 69,2), e progrediram até 28,4kcal/kg/dia

show abstract

A prospective survey of nutritional support practices in intensive care unit patients: What is prescribed? What is delivered?

Cited by 354 publications

References 20 publications

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)

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)

Evidence-based Nutritional Support in the Intensive Care Unit

Suprimento de micronutrientes, adequação energética e progressão da dieta enteral em adultos hospitalizados

Contact Info

Product

Resources

About