Shuofei Yang1, Jianming Guo2, Qihong Ni3, Jiaquan Chen4, Xiangjiang Guo5, Guanhua Xue6, Meng Ye7, Lan Zhang8. 1. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Pujian Road 160, Shanghai, 200127, PR China. Electronic address: doctor_yangshuofei@163.com. 2. Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, PR China. Electronic address: guojianming@aliyun.com. 3. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Pujian Road 160, Shanghai, 200127, PR China. Electronic address: niqihong1989@163.com. 4. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Pujian Road 160, Shanghai, 200127, PR China. Electronic address: p.s.rocky@hotmail.com. 5. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Pujian Road 160, Shanghai, 200127, PR China. Electronic address: guoxiang2008@163.com. 6. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Pujian Road 160, Shanghai, 200127, PR China. Electronic address: guanhuaxue@yeah.net. 7. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Pujian Road 160, Shanghai, 200127, PR China. Electronic address: 13817145123@163.com. 8. Department of Vascular Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Pujian Road 160, Shanghai, 200127, PR China. Electronic address: zhanglanrjxg@gmail.com.
Abstract
BACKGROUND: Little data evaluate the enteral nutrition (EN) for patients with acute mesenteric ischaemia (AMI) in the intensive care unit (ICU). This study assessed the outcomes of EN for recanalised AMI patients in the ICU. METHODS: In this retrospective study, 183 AMI patients with mesenteric recanalisation admitted to two surgical ICUs were included. Patients were divided into EN (EN within first week, n = 95) and total parenteral nutrition (TPN) group (TPN in 1st week, n = 88). The etiology, outcomes and complications were compared. Nutritional, immunologic, inflammatory response and mesenteric reperfusion were evaluated. Subgroup analysis and cost-assessment were performed. RESULTS: No significant difference of demographics and illness severity at baseline were found. The rates of TPN for ≥6 months (7.4% vs. 18.2%, P < 0.01), infectious complications (7.4% vs. 20.5%, P = 0.01) and acute respiratory distress syndrome (4.2% vs. 13.6%, P < 0.01) were lower in EN group. For patients with mesenteric infarction (n = 101), EN was associated with earlier bowel continuity restoration (P < 0.01) and lower 30-day mortality (7.3% vs. 26.1%, P = 0.01). For patients without initial bowel resection (n = 82), length of ICU and hospital stay was significantly shortened in EN group. The 1-year survival was 88.4% in EN group and 78.4% in TPN group (P = 0.031). EN was cost-effective, with improved inflammatory response and elevated peak velocity of mesenteric flow. CONCLUSIONS: For recanalised AMI patients, EN starting within the first week represents a favourable alternative to TPN. A multicentre randomised controlled trial with high level of evidence is warranted in the future. CLINICAL RELEVANCY STATEMENT: Acute mesenteric ischaemia (AMI) is a catastrophic abdominal vascular emergency in the surgical intensive care unit (ICU), and the mortality of AMI remains unchanged despite significant progress of endovascular techniques. A multidisciplinary and multimodal management approach of AMI in the ICU has been recently proposed to improve patient's survival and prevent the intestinal failure. Post-recanalisation nutrition therapy may significantly improve the overall survival of AMI patients is quite underemphasised in the ICU. Definitive data comparing EN with TPN for this patient population are very lacking. This study provides the clinical data to suggest that early EN starting after ICU admission represents a favourable alternative to TPN for recanalised AMI patients. The nutrition therapy protocol in the ICU for this special cohort needs to be updated with more high-level evidence in the future.
BACKGROUND: Little data evaluate the enteral nutrition (EN) for patients with acute mesenteric ischaemia (AMI) in the intensive care unit (ICU). This study assessed the outcomes of EN for recanalised AMIpatients in the ICU. METHODS: In this retrospective study, 183 AMIpatients with mesenteric recanalisation admitted to two surgical ICUs were included. Patients were divided into EN (EN within first week, n = 95) and total parenteral nutrition (TPN) group (TPN in 1st week, n = 88). The etiology, outcomes and complications were compared. Nutritional, immunologic, inflammatory response and mesenteric reperfusion were evaluated. Subgroup analysis and cost-assessment were performed. RESULTS: No significant difference of demographics and illness severity at baseline were found. The rates of TPN for ≥6 months (7.4% vs. 18.2%, P < 0.01), infectious complications (7.4% vs. 20.5%, P = 0.01) and acute respiratory distress syndrome (4.2% vs. 13.6%, P < 0.01) were lower in EN group. For patients with mesenteric infarction (n = 101), EN was associated with earlier bowel continuity restoration (P < 0.01) and lower 30-day mortality (7.3% vs. 26.1%, P = 0.01). For patients without initial bowel resection (n = 82), length of ICU and hospital stay was significantly shortened in EN group. The 1-year survival was 88.4% in EN group and 78.4% in TPN group (P = 0.031). EN was cost-effective, with improved inflammatory response and elevated peak velocity of mesenteric flow. CONCLUSIONS: For recanalised AMIpatients, EN starting within the first week represents a favourable alternative to TPN. A multicentre randomised controlled trial with high level of evidence is warranted in the future. CLINICAL RELEVANCY STATEMENT: Acute mesenteric ischaemia (AMI) is a catastrophic abdominal vascular emergency in the surgical intensive care unit (ICU), and the mortality of AMI remains unchanged despite significant progress of endovascular techniques. A multidisciplinary and multimodal management approach of AMI in the ICU has been recently proposed to improve patient's survival and prevent the intestinal failure. Post-recanalisation nutrition therapy may significantly improve the overall survival of AMIpatients is quite underemphasised in the ICU. Definitive data comparing EN with TPN for this patient population are very lacking. This study provides the clinical data to suggest that early EN starting after ICU admission represents a favourable alternative to TPN for recanalised AMIpatients. The nutrition therapy protocol in the ICU for this special cohort needs to be updated with more high-level evidence in the future.
Authors: E B Kiseleva; M G Ryabkov; M A Sizov; E L Bederina; A D Komarova; A A Moiseev; M V Bagryantsev; A N Vorobiev; N D Gladkova Journal: Sovrem Tekhnologii Med Date: 2021-08-28