Tolerability and efficacy of a low-volume enteral supplement containing key nutrients in the critically ill

Schneider, Andrea; Markowski, Andrea; Momma, M.; Seipt, Claudia; Luettig, Birgit; Hadem, Johannes; Wilhelmi, Michaela; Manns, Michael P.; Wedemeyer, Jochen

doi:10.1016/j.clnu.2011.04.003

Cited by 30 publications

(46 citation statements)

References 32 publications

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“…Of these, we excluded 20 for the following reasons: 8 trials did not include ICU patients (mostly surgery patients) [22–29]; 1 study did not evaluate clinical outcomes [30]; 1 study compared high-dose with low-dose Se [31]; 3 articles were duplicates [32–34]; 4 articles were systematic reviews; 1 trial was published as an abstract [35], and we were unable to obtain the data from the authors to complete our data abstraction process; 1 study was not an RCT [36]; and in 1 trial Se was not given intravenously [37]. …”

Section: Resultsmentioning

confidence: 99%

High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis

et al. 2016

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BackgroundSelenium (Se) is an essential trace element with antioxidant, anti-inflammatory, and immunomodulatory effects. So far, several randomized clinical trials (RCTs) have demonstrated that parenteral Se may improve clinical outcomes in intensive care unit (ICU) patients. Since publication of our previous systematic review and meta-analysis on antioxidants in the ICU, reports of several trials have been published, including the largest RCT on Se therapy. The purpose of the present systematic review was to update our previous data on intravenous (IV) Se in the critically ill.MethodsWe searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials. We included RCTs with parallel groups comparing parenteral Se as single or combined therapy with placebo. Potential trials were evaluated according to specific eligibility criteria, and two reviewers abstracted data from original trials in duplicate independently. Overall mortality was the primary outcome; secondary outcomes were infections, ICU length of stay (LOS), hospital LOS, ventilator days, and new renal dysfunction.ResultsA total of 21 RCTs met our inclusion criteria. When the data from these trials were aggregated, IV Se had no effect on mortality (risk ratio [RR] 0.98, 95 % CI 0.90–1.08, P = 0.72, heterogeneity I 2 = 0 %). In addition, when the results of ten trials in which researchers reported on infections were statistically aggregated, there was no significant treatment effect of parenteral Se (RR 0.95, 95 % CI 0.88–1.02, P = 0.15, I 2 = 0 %). There was no positive or negative effect of Se therapy on ICU and hospital LOS, renal function, or ventilator days.ConclusionsIn critically ill patients, IV Se as monotherapy does not improve clinical outcomes.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1529-5) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis

et al. 2016

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“…Of these, we excluded 34 due to the following reasons: 14 trials did not include ICU patients [27-40]; 4 trials did not evaluate clinically important outcomes [41-44]; 7 trials studied nutrients other than micronutrients (vitamins and trace elements) [19,20,45-49]; 3 trials were duplicated publications of included trials [50-52]; 2 were meta-analysis or systematic reviews [15,53]; and 3 additional trials were excluded because one was published only as an abstract without possibility to access the full article [54] and one was pseudorandomized [55]. In the end, 21 RCTs including 2,531 patients met the inclusion criteria and were included in this systematic review [13-18,56-70] (Additional file 2, Table s2; Additional file 3, Table s3). The authors reached 100% agreement for inclusion of relevant trials in this review.…”

Section: Resultsmentioning

confidence: 99%

“…These have been reviewed in prior meta-analyses but since these publications [11,12], additional RCTs have been reported [13-18]. The aim of the current study was to provide an up-to-date systematic review and meta-analysis on all randomized clinical studies of vitamins and trace elements as pharmaconutrient therapy on relevant clinical outcomes in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis

et al. 2012

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IntroductionCritical illness is characterized by oxidative stress, which is a major promoter of systemic inflammation and organ failure due to excessive free radical production, depletion of antioxidant defenses, or both. We hypothesized that exogenous supplementation of trace elements and vitamins could restore antioxidant status, improving clinical outcomes.MethodsWe searched computerized databases, reference lists of pertinent articles and personal files from 1980 to 2011. We included randomized controlled trials (RCTs) conducted in critically ill adult patients that evaluated relevant clinical outcomes with antioxidant micronutrients (vitamins and trace elements) supplementation versus placebo.ResultsA total of 21 RCTs met inclusion criteria. When the results of these studies were statistically aggregated (n = 20), combined antioxidants were associated with a significant reduction in mortality (risk ratio (RR) = 0.82, 95% confidence interval (CI) 0.72 to 0.93, P = 0.002); a significant reduction in duration of mechanical ventilation (weighed mean difference in days = -0.67, 95% CI -1.22 to -0.13, P = 0.02); a trend towards a reduction in infections (RR= 0.88, 95% CI 0.76 to 1.02, P = 0.08); and no overall effect on ICU or hospital length of stay (LOS). Furthermore, antioxidants were associated with a significant reduction in overall mortality among patients with higher risk of death (>10% mortality in control group) (RR 0.79, 95% CI 0.68 to 0.92, P = 0.003) whereas there was no significant effect observed for trials of patients with a lower mortality in the control group (RR = 1.14, 95% 0.72 to 1.82, P = 0.57). Trials using more than 500 μg per day of selenium showed a trend towards a lower mortality (RR = 0.80, 95% CI 0.63 to 1.02, P = 0.07) whereas trials using doses lower than 500 μg had no effect on mortality (RR 0.94, 95% CI 0.67 to 1.33, P = 0.75).ConclusionsSupplementation with high dose trace elements and vitamins may improve outcomes of critically ill patients, particularly those at high risk of death.

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“…The German study of Schneider et al .,[24] that studied low-volume enteral supplementation in ICU, had somewhat younger patients (47 years, 57% male). The APACHE II score of our patients, however, was substantially lower than in those three studies (our mean was 14.5, compared with 25.3 in the Arabi et al ., study,[13] 23.8 in Altintas et al .,[12] or 21.6 in Schneider et al .,[24]). This difference can be explained because their patients required parenteral nutrition[13] or mechanical ventilation;[12] or were primarily polytrauma or sepsis patients.…”

Section: Discussionmentioning

confidence: 99%

“…This difference can be explained because their patients required parenteral nutrition[13] or mechanical ventilation;[12] or were primarily polytrauma or sepsis patients. [24] In contrast, our sample was constituted by a wide variety of patients with mild to moderate severity in their critical illness state.…”

Section: Discussionmentioning

confidence: 99%

Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

Rugéles¹,

Rueda²,

Díaz³

et al. 2013

Indian Journal of Critical Care Medicine

103

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Introduction:Our aim was to evaluate the impact of hyperproteic hypocaloric enteral feeding on clinical outcomes in critically ill patients, particularly on severity of organic failure measured with the Sequential Organ Failure Assessment (SOFA).Materials and Methods:In a double blind clinical trial, 80 critically ill adult patients were randomized to hyperproteic hypocaloric or to isocaloric enteral nutrition; all patients completed follow-up of at least 4 days. Prescribed caloric intake was: Hyperproteic hypocaloric enteral nutrition (15 kcal/kg with 1.7 g/kg of protein) or isocaloric enteral nutrition (25 kcal/kg with 20% of the calories as protein). The main outcome was the differences in delta SOFA at 48 h. Secondary outcomes were intensive care unit (ICU) length of stay, days on ventilator, hyperglycemic events, and insulin requirements.Results:There were no differences in SOFA score at baseline (7.5 (standard deviation (SD) 2.9) vs 6.7 (SD 2.5) P = 0.17). The total amount of calories delivered was similarly low in both groups (12 kcal/kg in intervention group vs 14 kcal/kg in controls), but proteic delivery was significantly different (1.4 vs 0.76 g/kg, respectively P ≤ 0.0001). The intervention group showed an improvement in SOFA score at 48 h (delta SOFA 1.7 (SD 1.9) vs 0.7 (SD 2.8) P = 0.04) and less hyperglycemic episodes per day (1.0 (SD 1.3) vs 1.7 (SD 2.5) P = 0.017).Discussion:Enteral hyperproteic hypocaloric nutrition therapy could be associated with a decrease in multiple organ failure measured with SOFA score. We also found decreased hyperglycemia and a trend towards less mechanical ventilation days and ICU length of stay.

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Tolerability and efficacy of a low-volume enteral supplement containing key nutrients in the critically ill

Cited by 30 publications

References 32 publications

High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis

High-dose intravenous selenium does not improve clinical outcomes in the critically ill: a systematic review and meta-analysis

Antioxidant micronutrients in the critically ill: a systematic review and meta-analysis

Hyperproteic hypocaloric enteral nutrition in the critically ill patient: A randomized controlled clinical trial

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