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Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure.
MedLine Citation:
PMID:  21242788     Owner:  NLM     Status:  MEDLINE    
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.
Todd W Rice; Susan Mogan; Margaret A Hays; Gordon R Bernard; Gordon L Jensen; Arthur P Wheeler
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-25     Completed Date:  2011-08-18     Revised Date:  2013-07-02    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  967-74     Citation Subset:  AIM; IM    
Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
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MeSH Terms
Academic Medical Centers
Acute Disease
Enteral Nutrition / methods*
Follow-Up Studies
Hospital Mortality / trends
Intensive Care / methods
Intensive Care Units
Kaplan-Meier Estimate
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
Comment In:
Crit Care Med. 2011 Oct;39(10):2382; author reply 2382-3   [PMID:  21926507 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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