Document Detail


Current practice in nutritional support and its association with mortality in septic patients--results from a national, prospective, multicenter study.
MedLine Citation:
PMID:  18496367     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify current clinical practice regarding nutrition and its association with morbidity and mortality in patients with severe sepsis or septic shock in Germany. DESIGN: Nationwide prospective, observational, cross-sectional, 1-day point-prevalence study. SETTING: The study included 454 intensive care units from a representative sample of 310 hospitals stratified by size. PATIENTS: Participants were 415 patients with severe sepsis or septic shock (according to criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Data were collected by on-site audits of trained external study physicians during randomly scheduled visits during 1 yr. Valid data on nutrition were available for 399 of 415 patients. The data showed that 20.1% of patients received exclusively enteral nutrition, 35.1% exclusively parenteral nutrition, and 34.6% mixed nutrition (parenteral and enteral); 10.3% were not fed at all. Patients with gastrointestinal/intra-abdominal infection, pancreatitis or neoplasm of the gastrointestinal tract, mechanical ventilation, or septic shock were less likely to receive exclusively enteral nutrition. Median Acute Physiology and Chronic Health Evaluation II and Sepsis-related Organ Failure Assessment scores were significantly different among the nutrition groups. Overall hospital mortality was 55.2%. Hospital mortality was significantly higher in patients receiving exclusively parenteral (62.3%) or mixed nutrition (57.1%) than in patients with exclusively enteral nutrition (38.9%) (p = .005). After adjustment for patient morbidity (Acute Physiology and Chronic Health Evaluation II score, presence of septic shock) and treatment factors (mechanical ventilation), multivariate analysis revealed that the presence of parenteral nutrition was significantly predictive of mortality (odds ratio, 2.09; 95% confidence interval, 1.29-3.37). CONCLUSIONS: Patients with severe sepsis or septic shock in German intensive care units received preferentially parenteral or mixed nutrition. The use of parenteral nutrition was associated with an increased risk of death.
Authors:
Gunnar Elke; Dirk Schädler; Christoph Engel; Holger Bogatsch; Inez Frerichs; Maximilian Ragaller; Jens Scholz; Frank M Brunkhorst; Markus Löffler; Konrad Reinhart; Norbert Weiler;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Critical care medicine     Volume:  36     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-06-03     Completed Date:  2008-06-17     Revised Date:  2009-03-25    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1762-7     Citation Subset:  AIM; IM    
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Germany. elke@anaesthesie.uni-kiel.de
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MeSH Terms
Descriptor/Qualifier:
APACHE
Aged
Critical Pathways*
Cross-Sectional Studies
Enteral Nutrition / mortality*
Female
Germany
Health Facility Size / statistics & numerical data
Hospital Mortality
Hospitals, General / statistics & numerical data
Hospitals, University / statistics & numerical data
Humans
Intensive Care Units / statistics & numerical data
Length of Stay / statistics & numerical data
Male
Medical Audit / statistics & numerical data
Middle Aged
Odds Ratio
Parenteral Nutrition, Total / mortality*
Prospective Studies
Shock, Septic / mortality*,  therapy*
Survival Rate
Comments/Corrections
Comment In:
Crit Care Med. 2008 Jun;36(6):1964-5   [PMID:  18520654 ]
Crit Care Med. 2009 Mar;37(3):1179; author reply 1179-80   [PMID:  19237966 ]
Crit Care Med. 2009 Mar;37(3):1176-7; author reply 1177   [PMID:  19237961 ]

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