Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury

Taylor, Stephen J.; Fettes, S. B.; Jewkes, Claire; Nelson, R. J.

doi:10.1097/00003246-199911000-00033

Cited by 373 publications

(276 citation statements)

References 31 publications

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“…Six RCTs317, 318, 319, 320, 321, 322 included in the systematic review of the JSICM guidelines were extracted. All six RCTs reported on mortality rate, three reported on infection frequency, two RCTs reported on the duration of ventilation, the length of ICU stay, and length of hospital stay; four RCTs reported on ventilator‐associated pneumonia (VAP), and two RCTs reported on the frequency of continuous renal replacement therapy (CRRT) use.…”

Section: Cq13: Nutritionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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Background and PurposeThe Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG 2016), a Japanese‐specific set of clinical practice guidelines for sepsis and septic shock created jointly by the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine, was first released in February 2017 in Japanese. An English‐language version of these guidelines was created based on the contents of the original Japanese‐language version.MethodsMembers of the Japanese Society of Intensive Care Medicine and the Japanese Association for Acute Medicine were selected and organized into 19 committee members and 52 working group members. The guidelines were prepared in accordance with the Medical Information Network Distribution Service (Minds) creation procedures. The Academic Guidelines Promotion Team was organized to oversee and provide academic support to the respective activities allocated to each Guideline Creation Team. To improve quality assurance and workflow transparency, a mutual peer review system was established, and discussions within each team were open to the public. Public comments were collected once after the initial formulation of a clinical question (CQ), and twice during the review of the final draft. Recommendations were determined to have been adopted after obtaining support from a two‐thirds (>66.6%) majority vote of each of the 19 committee members.ResultsA total of 87 CQs were selected among 19 clinical areas, including pediatric topics and several other important areas not covered in the first edition of the Japanese guidelines (J‐SSCG 2012). The approval rate obtained through committee voting, in addition to ratings of the strengths of the recommendation and its supporting evidence were also added to each recommendation statement. We conducted meta‐analyses for 29 CQs. Thirty seven CQs contained recommendations in the form of an expert consensus due to insufficient evidence. No recommendations were provided for 5 CQs.ConclusionsBased on the evidence gathered, we were able to formulate Japanese‐specific clinical practice guidelines that are tailored to the Japanese context in a highly transparent manner. These guidelines can easily be used not only by specialists, but also by non‐specialists, general clinicians, nurses, pharmacists, clinical engineers, and other healthcare professionals.

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Section: Cq13: Nutritionmentioning

confidence: 99%

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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“…Schilling et al (1996) did not find significant differences in phagocytic activity of monocytes, activated surface antigen HLA-DR, and CRP levels between a control formula and a formula supplemented with arginine, omega 3 fatty acids and nucleotides; however both formulas were better than a low energy=low fat intravenous solution. However, Taylor et al (1999) showed a decrease in CRP levels in head injury patients treated with an enhanced formula without differences in other biochemical parameters. These results were confirmed by Weimann et al (1998) in a group of multiple organ failure patients.…”

Section: Discussionmentioning

confidence: 80%

Effect of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients

et al. 2003

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Objective: It is known that the immune system is frequently affected in patients with head and neck cancer. Although immune dysfunction could be multifactorial, this immune system may be modulated by specific nutritional substrates, such as arginine. The aim of our study was to evaluate the effect of enteral nutrition supplemented with arginine on c-reactive protein (CRP), interleukin 6 (IL-6) and tumour necrosis factor (TNFa) in surgical head and neck cancer patients. Design: Randomized trial. Setting: Tertiary care. Subjects: A population of 36 patients with oral and laryngeal cancer were enrolled. Interventions: At surgery patients were randomly allocated to two groups: (a) patients receiving an enteral diet supplements with arginine and dietary fibre (group I, n ¼ 18); (b) patients receiving an isocaloric, isonitrogenous enteral formula (group II, n ¼ 18). Perioperatively and on postoperative day 5 the following parameters were evaluated: serum values of prealbumin, transferrin, albumin, total number of lymphocytes, interleukin 6, tumour necrosis factor a and c-reactive protein.Results: The mean age was 59.6 AE 10.9 y (two females=34 males). No significant intergroup differences in the trend of the three plasma proteins and weight were detected. CRP decreased in both groups (group I: 152.9 AE 76.9 vs 68.9 AE 82.5 mg=dl; P < 0.05; and group II: 105.9 AE 92 vs 43.6 AE 59.1 mg=dl; P < 0.05). Interleukin 6 did not change (group I: 16.3 AE 12.3 vs 35.6 AE 83.4 pg=ml; NS; and group II: 22.8 AE 40 vs 9.9 AE 17.7 pg=ml; NS). TNFa did not show any differences (group I: 4.6 AE 1.6 vs 5.1 AE 1.5 pg=ml; NS; and group II: 8.8 AE 6.1 vs 5.8 AE 1.7 pg=ml; NS). Lymphocytes increased in both groups (group I: 1405.6 AE 517 vs 1634 AE 529Â10 6 =ml; P < 0.05; and group II: 1355 AE 696 vs 1561 AE 541Â10 6 =ml; P < 0.05). Conclusions: Enhanced formula did not change IL6 and TNFa levels. Further studies are needed to determine whether route of nutrition or type of formula is the key in these patients.

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“…recommend the advancement of feeding toward the target over the 48 -72 h after the start of EEN [1], and the Canadian Clinical Practice Guidelines (CCPG) recommend starting at target feeding rate when initiating EN in critically ill patients [2]. Several studies support each of these recommendations [9]- [14]. Taylor feeding in patients with a BMI of approximately 28 kg/m 2 in the first 7 days in an ICU [14], and found that the normocaloric group had a lower incidence of nosocomial infection than the hypocaloric group.…”

Section: Discussionmentioning

confidence: 99%

“…Importantly, however, many of these studies were conducted in Western countries in patients with normal weight or excessive body weight (BW). For underweight patients with limited nutritional reserves, advancing feeding too slowly might result in undernutrition or poor clinical outcomes [9]- [14]. We previously reported that reduced energy intake during the first week of ICU admission was associated with a reduced duration of mechanical ventilation (MV) in critically ill, underweight patients [15].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Rate of Feeding Advancement after Early Initiation of Enteral Nutrition in Critically Ill, Underweight Patients: A Single-Center Retrospective Chart Review

Ichimaru¹,

Sono²,

Fujiwara³

et al. 2016

FNS

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Background: The optimal rate of feeding advancement after initiation of early enteral nutrition (EEN) for underweight, critically ill patients is unknown. Methods: We conducted a retrospective chart review in intensive care unit (ICU) patients with a body mass index (BMI) < 20.0 kg/m 2 . Patients were categorized into Group R, which reached the energy target within 3 days of EEN initiation, and Group S, which reached the energy target 4 or more days after EEN initiation. Results: A total of 65 patients with a median age of 73 years were included in the study. No significant differences were observed between the two groups for all-cause mortality, ICU-free days, or length of hospital stay. Ventilator-free days (VFDs) were significantly fewer in Group R than in Group S (18.0 [0.0 -22.0] vs. 21.0 [16.3 -24.8] days; P = 0.046). A significantly higher number of patients requiring mechanical ventilation (MV) at hospital discharge were observed in Group R than in Group S (29% vs. 8%; P = 0.030). Multivariable analyses with adjustment for confounders found that days required to reach target energy intake after EEN initiation were significantly and independently associated with the requirement for MV at hospital discharge, but not with VFDs. Conclusion: A slow rate of feeding advancement after initiation of EEN in critically ill patients having a BMI of <20.0 kg/m 2 might be associated with a reduced requirement for MV at hospital discharge. These results require confirmation in a large multicenter trial of underweight, critically ill patients.

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Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury

Abstract: Enhanced EN appears to accelerate neurologic recovery and reduces both the incidence of major complications and postinjury inflammatory responses.

Cited by 373 publications

References 31 publications

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

The Japanese Clinical Practice Guidelines for Management of Sepsis and Septic Shock 2016 (J‐SSCG2016)

Effect of c-reactive protein and interleukins blood levels in postsurgery arginine-enhanced enteral nutrition in head and neck cancer patients

The Impact of Rate of Feeding Advancement after Early Initiation of Enteral Nutrition in Critically Ill, Underweight Patients: A Single-Center Retrospective Chart Review

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