The favorable effect of early parenteral feeding on survival in head-injured patients

Rapp, Robert P.; Pharm, D; Young, Byron; Twyman, Diana; Bivins, Brack A.; Haack, Dennis; Tibbs, Phillip A.; Bean, James

doi:10.3171/jns.1983.58.6.0906

Cited by 278 publications

(98 citation statements)

References 16 publications

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“…These studies included eleven RCTs concerning mortality rates295, 296, 297, 299, 300, 301, 302, 303, 304, 305, 306 and seven RCTs concerning infection frequency 297, 298, 299, 300, 301, 302, 305…”

Section: Cq13: Nutritionmentioning

confidence: 99%

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

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‐SSCG 2016)

Nishida

Ogura

Egi

et al. 2018

Acute Medicine & Surgery

157

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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%

“…Adams et al 15 Borzotta et al 16 Cerra et al 17 Dunham et al 18 Gianotti et al 19 Hadfield et al 14 Kalfarentzos et al 20 Kudsk et al 21 Radrizzani et al 12 Rapp et al 22 Reynolds et al 23 Woodcock et al 24 Rayes et al 25 Overall Gianotti et al 19 Kalfarentzos et al 20 Radrizzani et al 12 Rayes et al 25 Overall …”

Section: Primarymentioning

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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“…Of note, food intolerance may be associated with increased morbidity and increased hospital stay costs. (2,3) Considering the paucity of both national and international studies correlating SAH, ICH and gastric emptying (GE), the main objective of this paper is to compare and discuss physiological and pathophysiological related to SAH, ICH and gut motility. …”

mentioning

confidence: 99%

Lesões cerebrais agudas e sua influência sobre a motilidade gastrintestinal

Lucena¹,

Tibúrcio²,

Vasconcelos³

et al. 2011

Rev. bras. ter. intensiva

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REVIEW ARTICLEmeans of food administration to brain injury patients as tool to reduce gastrointestinal symptoms. Of note, food intolerance may be associated with increased morbidity and increased hospital stay costs. (2,3) Considering the paucity of both national and international studies correlating SAH, ICH and gastric emptying (GE), the main objective of this paper is to compare and discuss physiological and pathophysiological related to SAH, ICH and gut motility. METHODSA literature search was conducted to analyze the pattern of gut motility following acute brain injury with ICH. Articles discussing possible therapeutic approaches for ICH-related gut complications were also evaluated. The literature search included national and international health sciences journals, and we searched for articles related to the brain-gastrointestinal tract functional axis and its behavior either in experimental animal models of brain injury or acute brain injury patients. Using the inclusion criteria, a web based search was conducted on the following electronic libraries: Scientific Electronic Library Online (Scielo) © , Periódicos/Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) © , PubMed/Medline© and Google Scholar Beta © .Twenty-five articles published between 1982 and 2010 were selected. Of those, eleven focused on the influence of ICH on gut motility (GM), ten discussed means of nutrition of administration in moderate to severe head trauma (HT) (Glasgow coma scale < 8), and finally, four articles discussed the main metabolic changes in head trauma subjects, with an emphasis on nutritional support. Influence of intracranial hypertension on gut motilityEleven articles about ICH influence about gut motility were analyzed. Five (45.4%) were related to gastric and intestinal emptying, four (36.3%) focused on pressure changes throughout the gastrointestinal tract (GIT) (two studied the amplitude and frequency of food propellant contractions, and the other two analyzed the inferior esophageal sphincter behavior under ICH conditions), and two (18.1%) studies evaluated GIT electrical activity, studying the migratory myoelectric complex by means of body surface electrodes or electrogastrogram. Of all of the articles, two (18.8%) reported that HIC variation is directly proportional to gastric contraction intensity, based on a GE analysis of the amplitude and frequency of contractions in anesthetized rats with intra-cerebral cannulation-induced ICH. The remaining nine (81.8%) articles found that increased ICP is related to slower GIT transit, and this food bolus transit delay is associated with intolerance to enteral nutrition. Pharmacological intervention to accelerate the GIT was evaluated in one of the analyzed articles. Another study was designed to evaluate the association between ICP changes in thirty-seven intracranial tumor patients who performed Valsalva's maneuver during evacuation. All patients performed the maneuver, independent of constipation, and no increased ICP decompensation was observed. Additi...

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The favorable effect of early parenteral feeding on survival in head-injured patients

Cited by 278 publications

References 16 publications

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

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

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)

Lesões cerebrais agudas e sua influência sobre a motilidade gastrintestinal

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