Early enteral administration of a formula (Impact) supplemented with arginine, nucleotides, and fish oil in intensive care unit patients: results of a multicenter, prospective, randomized, clinical trial
Bower RH, Cerra FB, Bershadsky B, Licari JJ, Hoyt DB, Jensen GL, Van Buren CT, Rothkopf MM, Daly JM, Adelsberg BR
Critical care medicine · 330 citas
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Cómo se estudió
- Diseño
- Ensayo controlado aleatorizado (indexado por PubMed)
- Estudiado en
- Personas
- Resultado principal
- Eventos clínicos como enfermedad o muerte
Quién lo pagó
- Financiación
- Financiación no declarada
Publicación
- Publicado
- 1995-03-01 · Crit Care Med · vol. 23 · número 3 · págs. 436–449
- Editorial
- Lippincott Williams & Wilkins
- Citado
- 589 citas · más que el 100% de estudios similares · 52.9× el promedio de su campo
- Impacto
- Entre el 10 % más citado de su campo
- Referencias
- 30 trabajos
- Acceso
- De pago
- Áreas de investigación
- Clinical Nutrition and Gastroenterology · Infant Nutrition and Health · Nosocomial Infections in ICU
- Palabras clave
- early enteral nutrition, arginine supplementation, dietary nucleotides, fish oil, omega-3 fatty acids, enteral nutrition, intensive care unit patients, sepsis, systemic inflammatory response syndrome, length of hospital stay, infectious complications, nitrogen balance, plasma arginine, ornithine, eicosapentaenoic acid, docosahexaenoic acid
- MeSH
- humans, nucleotides, fatty acids, omega-3, fish oils, arginine, enteral nutrition, critical care, length of stay, apache, multivariate analysis, prospective studies, double-blind method, food, fortified, adolescent, adult, aged, aged, 80 and over, middle aged, female, male, infections
10 autores
- Robert H. Bower🇺🇸University of Cincinnati
- Frank B. Cerra
- Boris Bershadsky
- Jerome Licari
- David B. Hoyt
- Gordon Lee Jensen
- Charles T. Van Buren
- Michael M. Rothkopf
- John M. Daly
- Bernard R. Adelsberg
Resumen
El texto original del estudio, en el idioma en que se publicó.
Objective
To determine if early enteral feeding, in an intensive care unit (ICU) patient population, using a formula supplemented with arginine, dietary nucleotides, and fish oil (Impact), results in a shorter hospital stay and a reduced frequency of infectious complications, when compared with feeding a common use enteral formula (Osmolite.HN).
Design
A prospective, randomized, double-blind, multicenter trial.
Setting
ICUs in eight different hospitals.
Patients
Of 326 patients enrolled in the study, 296 patients were eligible for analysis. They were admitted to the ICU after an event such as trauma, surgery, or sepsis, and met a risk assessment screen (Acute Physiology and Chronic Health Evaluation II [APACHE II] score of > or = 10, or a Therapeutic Intervention Scoring System score of > or = 20) and study eligibility requirements. Patients were stratified by age ( or = 60 yrs of age) and disease (septic or systemic inflammatory response syndrome).
Interventions
Patients were enrolled and full-strength tube feedings were initiated within 48 hrs of the study entry event. Enteral feedings were advanced to a target volume of 60 mL/hr by 96 hrs of the event. One hundred sixty-eight patients were randomized to receive the experimental formula, and 158 patients were randomized to receive the common use control formula.
Measurements and main results
Both groups tolerated early enteral feeding well, and the frequency of tube feeding-related complications was low. There were no significant differences in nitrogen balance between groups on study days 4 and 7. Patients receiving the experimental formula had a significant (p = .0001) increase in plasma arginine and ornithine concentrations by study day 7. Plasma fatty acid profiles demonstrated higher concentrations of linoleic acid (p < .01) in the patients receiving the common use formula and higher concentrations of eicosapentaenoic and docosahexaenoic acid (p < .01) in the patients receiving the experimental formula. The mortality rate was not different between the groups and was significantly (p < .001) lower than predicted by the admission severity scores in both feeding groups. In patients who received at least 821 mL/day of the experimental formula, the hospital median length of stay was reduced by 8 days (p < .05). In patients stratified as septic, the median length of hospital stay was reduced by 10 days (p < .05), along with a major reduction in the frequency of acquired infections (p < .01) in the patients who received the experimental formula. In the septic subgroup fed at least 821 mL/day, the median length of stay was reduced by 11.5 days, along with a major reduction in acquired infections (both p < .05) in the patients who received the experimental formula.
Conclusions
Early enteral feeding of the experimental formula was safe and well tolerated in ICU patients. In patients who received the experimental formula, particularly if they were septic on admission to the study, a substantial reduction in hospital length of stay was observed, along with a significant reduction in the frequency of acquired infections.
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