Enteral nutrition practice in a surgical intensive care unit: what proportion of energy expenditure is delivered enterally?

Engel, Juliane; Mühling, J.; Jünger, Alexander; Menges, T.; Kärcher, B.; Hempelmann, G.

doi:10.1054/clnu.2002.0622

Cited by 65 publications

(65 citation statements)

References 21 publications

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“…No problems 151 (32) 163 (34) Slight problems 110 (24) 104 (22) Moderate problems 103 (22) 99 (21) Severe problems 65 (14) 62 (13) Extreme problems 38 (8) 45 (10) Pain/discomfort…”

Section: Results: Cost-effectivenessmentioning

confidence: 99%

“…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%

“…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.…”

Section: Background and Rationalementioning

confidence: 99%

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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

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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.

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“…No problems 151 (32) 163 (34) Slight problems 110 (24) 104 (22) Moderate problems 103 (22) 99 (21) Severe problems 65 (14) 62 (13) Extreme problems 38 (8) 45 (10) Pain/discomfort…”

Section: Results: Cost-effectivenessmentioning

confidence: 99%

Section: Discussionmentioning

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

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“…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

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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

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“…Some papers have shown that in critical care settings, underfeeding related to inability to deliver the required nutrients is very common. Repetitive fasting periods, enteral tube complications, and gastrointestinal intolerance are the most frequent reported problems (4)(5)(6)(7)(8)(9)(10)(11). A multicentric study showed that the greater quantity of calories and proteins delivered the more significant clinical improvement is found especially in patients with body mass index (BMI) lower than 25 kg/m² or greater than 35 kg/m² (12).…”

Section: Introductionmentioning

confidence: 99%

Déficit crítico de energía y mortalidad en pacientes críticos

Siqueira-Paese¹,

Dock-Nascimento

Aguilar-Nascimento

2016

Nutr Hosp

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ResumenObjetivo: investigar la infl uencia del défi cit de calorías y proteínas en la mortalidad y la duración de la estancia hospitalaria de pacientes críticos. Métodos: se realizó un estudio prospectivo de cohorte incluyendo 100 pacientes consecutivos en una unidad de cuidados intensivos (UCI) terciaria que recibían nutrición enteral o parenteral. Se registraron diariamente los défi cits de calorías y proteínas durante un máximo de 30 días. Los défi -cit de energía y proteínas fueron divididos en: défi cit crítico de calorías (≥ 480 kcal/día), défi cit calórico no crítico (≤ 480 kcal/día), défi cit crítico de proteínas (≥ 20 g/día) y défi cit de proteínas no crítico (≤ 20 g/día). Los resultados se correlacionaron con la estancia hospitalaria y la mortalidad. Resultados: la tasa de mortalidad fue de 33%. En general, los pacientes recibieron 65,4% y 67,7% de las necesidades calóricas y proteicas. El défi cit calórico crítico se encontró en el 72% de los casos y el défi cit proteico crítico en el 70% de ellos. Hubo una correlación signifi cativa entre la duración de la estancia con el défi cit calórico (R = 0,37; p < 0,001) y el défi cit de proteínas (R = 0,28; p < 0,001). El análisis de sobrevida mostró que la mortalidad fue mayor en los pacientes con défi cit calórico crítico (p < 0,001) o con défi cit proteico crítico (p < 0,01). El análisis de regresión de Cox mostró que el défi cit crítico de proteínas se asoció con mayor mortalidad (HR 0.25, IC 95% 0,07-0,93; p = 0,03). Conclusiones: la incidencia de défi cit de calorías y de proteínas en la UCI es alta. Tanto los défi cit calóricos como proteicos aumentan la duración de la estancia hospitalaria, y el défi cit de proteínas superior a 20 g/día es un factor independiente de mortalidad en la ICU. AbstractObjective: We investigate the infl uence of caloric and protein defi cit on mortality and length of hospital stay of critically ill patients. Methods: A cohort prospective study including 100 consecutive patients in a tertiary intensive care unit (ICU) receiving enteral or parenteral nutrition. The daily caloric and protein defi cit were collected each day for a maximum of 30 days. Energy defi cits were divided into critical caloric defi cit (≥ 480 kcal/day) and non-critical caloric defi cit (≤ 480 kcal/day); and in critical protein defi cit (≥ 20 g/day) and non-critical protein defi cit (≤ 20 g/day). The fi ndings were correlated with hospital stay and mortality. Results: The mortality rate was 33%. Overall, the patients received 65.4% and 67.7% of the caloric and protein needs. Critical caloric defi cit was found in 72% of cases and critical protein defi cit in 70% of them. There was a signifi cant correlation between length of stay and accumulated caloric defi cit (R = 0.37; p < 0.001) and protein defi cit (R = 0.28; p < 0.001). The survival analysis showed that mortality was greater in patients with both critical caloric (p < 0.001) and critical protein defi cits (p < 0.01). The Cox regression analysis showed that critical protein defi cit was associated w...

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Enteral nutrition practice in a surgical intensive care unit: what proportion of energy expenditure is delivered enterally?

Cited by 65 publications

References 21 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)

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

Déficit crítico de energía y mortalidad en pacientes críticos

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