| Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure. | |
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MedLine Citation:
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PMID: 21242788 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Enteral nutrition is provided to mechanically ventilated patients who cannot eat normally, yet the amount of support needed is unknown. We conducted this randomized, open-label study to test the hypothesis that initial low-volume (i.e., trophic) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure. DESIGN: Randomized, open-label study. PATIENTS: A total of 200 patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hrs. INTERVENTIONS: Patients were randomized to receive either initial trophic (10 mL/hr) or full-energy enteral nutrition for the initial 6 days of ventilation. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was ventilator-free days to day 28. Baseline characteristics were similar between the 98 patients randomized to trophic and the 102 patients randomized to full-energy nutrition. At enrollment, patients had a mean Acute Physiology and Chronic Health Evaluation II score of 26.9 and a PaO2/FiO2 ratio of 182 and 38% were in shock. Both groups received similar durations of enteral nutrition (5.5 vs. 5.1 days; p = .51). The trophic group received an average of 15.8% ± 11% of goal calories daily through day 6 compared to 74.8% ± 38.5% (p < .001) for the full-energy group. Both groups had a median of 23.0 ventilator-free days (p = .90) and a median of 21.0 intensive-care-unit-free days (p = .64). Mortality to hospital discharge was 22.4% for the trophic group vs. 19.6% for the full-energy group (p = .62). In the first 6 days, the trophic group had trends for less diarrhea (19% vs. 24% of feeding days; p = .08) and significantly fewer episodes of elevated gastric residual volumes (2% vs. 8% of feeding days; p < .001). CONCLUSION: Initial trophic enteral nutrition resulted in clinical outcomes in mechanically ventilated patients with acute respiratory failure similar to those of early full-energy enteral nutrition but with fewer episodes of gastrointestinal intolerance. |
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Authors:
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Todd W Rice; Susan Mogan; Margaret A Hays; Gordon R Bernard; Gordon L Jensen; Arthur P Wheeler |
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Publication Detail:
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Type: Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: Critical care medicine Volume: 39 ISSN: 1530-0293 ISO Abbreviation: Crit. Care Med. Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-05-25 Completed Date: 2011-08-18 Revised Date: 2012-10-15 |
Medline Journal Info:
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Nlm Unique ID: 0355501 Medline TA: Crit Care Med Country: United States |
Other Details:
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Languages: eng Pagination: 967-74 Citation Subset: AIM; IM |
Affiliation:
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Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA. todd.rice@vanderbilt.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00252616 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Academic Medical Centers Acute Disease Adult Aged Enteral Nutrition / methods* Female Follow-Up Studies Hospital Mortality / trends Humans Intensive Care / methods Intensive Care Units Kaplan-Meier Estimate Male Middle Aged Nutritional Requirements Parenteral Nutrition / methods* Respiration, Artificial* Respiratory Insufficiency / diagnosis, mortality, therapy* Risk Factors Statistics, Nonparametric Survival Rate Time Factors Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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1 UL1 RR024975/RR/NCRR NIH HHS; K23 HL081431-05/HL/NHLBI NIH HHS; K23HL81431/HL/NHLBI NIH HHS; P30DK058404/DK/NIDDK NIH HHS; R34 HL105869/HL/NHLBI NIH HHS |
| Comments/Corrections | |
Comment In:
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Crit Care Med. 2011 Oct;39(10):2382; author reply 2382-3
[PMID:
21926507
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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