Enteral nutrition better than proton pump inhibitors?

Jalil, Bilal; El‐Kersh, Karim

doi:10.1097/mcc.0000000000000620

Cited by 5 publications

(5 citation statements)

References 27 publications

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“…Several related questions are currently subject to ongoing research including comparing early trophic EN with no EN in the first 24 h [25][26][27][28][29].…”

Section: Question 2: What About En In Patients Receiving Vasopressor Agents?mentioning

confidence: 99%

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Preiser

Arabi

Berger³

et al. 2021

Crit Care

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The preferential use of the oral/enteral route in critically ill patients over gut rest is uniformly recommended and applied. This article provides practical guidance on enteral nutrition in compliance with recent American and European guidelines. Low-dose enteral nutrition can be safely started within 48 h after admission, even during treatment with small or moderate doses of vasopressor agents. A percutaneous access should be used when enteral nutrition is anticipated for ≥ 4 weeks. Energy delivery should not be calculated to match energy expenditure before day 4–7, and the use of energy-dense formulas can be restricted to cases of inability to tolerate full-volume isocaloric enteral nutrition or to patients who require fluid restriction. Low-dose protein (max 0.8 g/kg/day) can be provided during the early phase of critical illness, while a protein target of > 1.2 g/kg/day could be considered during the rehabilitation phase. The occurrence of refeeding syndrome should be assessed by daily measurement of plasma phosphate, and a phosphate drop of 30% should be managed by reduction of enteral feeding rate and high-dose thiamine. Vomiting and increased gastric residual volume may indicate gastric intolerance, while sudden abdominal pain, distension, gastrointestinal paralysis, or rising abdominal pressure may indicate lower gastrointestinal intolerance.

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“…Several related questions are currently subject to ongoing research including comparing early trophic EN with no EN in the first 24 h [25][26][27][28][29].…”

Section: Question 2: What About En In Patients Receiving Vasopressor Agents?mentioning

confidence: 99%

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Preiser

Arabi

Berger³

et al. 2021

Crit Care

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“…Based on our results, we believe that PPIs may not be appropriate for patients at low risk of UGIB. We recommend further clinical trials on large cohorts of patients to evaluate the benefits of using PPI in critically ill patients at low risk of UGIB 23 . Better identification of appropriate selection criteria for PPI and comparisons of pharmacologic prevention strategies are warranted.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Prognosis Analysis of Upper Gastrointestinal Bleeding in Patients With Acute Severe Cerebral Stroke

Chen

Lin

Zhang

et al. 2023

Journal of Clinical Gastroenterology

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Goals:We aim to explore the relationship between the use of proton pump inhibitors (PPIs) and upper gastrointestinal bleeding (UGIB). We develop a nomogram model to predict mortality in critically ill stroke patients.Study: This is a retrospective study based on the MIMIC IV database. We extracted clinical information including demographic data, comorbidities, and laboratory indicators. Univariate and multivariable logistic regressions were used to assess and identify risk factors for the occurrence of UGIB and for the in-hospital mortality of critically ill stroke patients. The resulting model was used to construct a nomogram for predicting in-hospital mortality.Results: Five thousand seven hundred sixteen patients from the MIMIC-IV database were included in our analysis. UGIB occurred in 109 patients (1.9%), whereas the PPI use rate was as high as 60.6%. Chronic liver disease, sepsis, shock, anemia, and increased level of urea nitrogen were independent risk factors for the occurrence of UGIB in severe stroke patients. We identified age, heart failure, shock, coagulopathy, mechanical ventilation, continuous renal replacement therapy, antiplatelet drugs, anticoagulation, simplified acute physiology score-II, and Glasgow coma score as independent risk factors for in-hospital mortality in severe stroke patients. The C-index for the final nomograms was 0.852 (95% confidence interval: 0.840, 0.864). Conclusions:We found that the overall rate of UGIB in severe stroke patients is low, whereas the rate of PPI usage is high. In our study, PPI was not identified as a risk factor for the occurrence of UGIB and UGIB was not associated with all-cause mortality. More clinical trials are needed to evaluate the benefits of using PPI in critically ill stroke patients.

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“…15,16 Accordingly, there is a lack of agreement in clinical practice regarding the use of pharmacological SUP in relation to enteral feed, leading to variation in practice and calls for larger clinical trials. 17 The SUP in the intensive care unit (SUP-ICU) trial was an international, blinded randomised controlled trial comparing the effects of prophylactic intravenous pantoprazole versus placebo on patientimportant outcomes in 3298 adult ICU patients at risk of GI bleeding. 18 There was no overall statistically significant difference between groups in the primary outcome of mortality (31.1% vs. 30.4%, relative risk (RR) 1.02, 95% confidence interval [CI] 0.91-1.13).…”

Section: Introductionmentioning

confidence: 99%

“…Accordingly, there is a lack of agreement in clinical practice regarding the use of pharmacological SUP in relation to enteral feed, leading to variation in practice and calls for larger clinical trials 17 …”

Section: Introductionmentioning

confidence: 99%

Associations between enteral nutrition and outcomes in the SUP‐ICU trial: Protocol for exploratory post hoc analyses

Borthwick

Granholm

Marker

et al. 2023

Acta Anaesthesiol Scand

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Critically ill patients are at risk of gastrointestinal (GI) bleeding. Counter measures to minimise this risk include the use of pharmacological stress ulcer prophylaxis (SUP). The effect of enteral nutrition as SUP on GI bleeding event rates is unknown. There are conflicting data describing the effect of co‐administration of enteral nutrition with pharmacological SUP, and there is substantial variation in practice. We aim to conduct an exploratory post hoc analysis to evaluate the association of enteral nutrition with clinically important GI bleed rates in ICU patients included in the SUP‐ICU trial, and to explore any interactions between enteral nutrition and pharmacologic SUP on patient outcomes. The SUP‐ICU trial dataset will be used to assess if enteral nutrition is associated with the outcomes of interest. Extended Cox models will be used considering relevant competing events, including treatment allocation (SUP or placebo) and enteral nutrition as a daily time‐varying covariate, with additional adjustment for severity of illness (SAPS II). Results will be presented as adjusted hazard ratios for treatment allocation and enteral nutrition, and for treatment allocation and enteral nutrition considering potential interactions with the other variable, all with 95% confidence intervals and p‐values for the tests of interaction. All results will be considered as exploratory only. This post hoc analysis may yield important insights to guide practice and inform the design of future randomised clinical trial investigating the effect of enteral nutrition on GI bleeding.

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Enteral nutrition better than proton pump inhibitors?

Cited by 5 publications

References 27 publications

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

Risk Factors and Prognosis Analysis of Upper Gastrointestinal Bleeding in Patients With Acute Severe Cerebral Stroke

Associations between enteral nutrition and outcomes in the SUP‐ICU trial: Protocol for exploratory post hoc analyses

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