Mette M Berger1, Olivier Pantet2, Nathalie Jacquelin-Ravel2, Mélanie Charrière2, Sabine Schmidt3, Fabio Becce3, Régine Audran4, François Spertini4, Luc Tappy5, Claude Pichard6. 1. Service of Adult Intensive Care and Burns, Lausanne University Hospital - CHUV, Rue du Bugnon 46, Lausanne, Switzerland. Electronic address: Mette.Berger@chuv.ch. 2. Service of Adult Intensive Care and Burns, Lausanne University Hospital - CHUV, Rue du Bugnon 46, Lausanne, Switzerland. 3. Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, Lausanne, Switzerland. 4. Division of Immunology and Allergy, Lausanne University Hospital, Lausanne, Switzerland. 5. Department of Physiology, University of Lausanne, Rue du Bugnon 7, CH-1005, Lausanne, Switzerland. 6. Clinical Nutrition, Geneva University Hospital, 1205 Geneva, Switzerland.
Abstract
BACKGROUND & AIMS:Individualized supplemental parenteral nutrition (SPN) providing measured energy expenditure from day 4 reduced infectious complications in a previous study including 305 intensive care (ICU) patients. The study aimed at investigating the metabolic, and immune responses underlying the clinical response of the previous trial. METHODS: Randomized controlled trial enrolling 23 critically ill patients on day 3 (D3) of admission to the ICU who were fed less than 60% of their energy target by theenteral nutrition (EN) alone: allocation to either continued EN or to SPN to a target validated by indirect calorimetry. Protein and glucose metabolism (primary endpoint) were investigated with tracer isotopes on D4 and D9. Secondary endpoints: 1) immune response, investigated in serum and in stimulated peripheral blood mononuclear cells (PMBC), by dosing a panel of cytokines (infectious complications were recorded), and 2) Muscle mass was assessed by ultrasound of the thigh. RESULTS: Comparable at baseline, the SPN group (n = 11) received more energy (median 24.3 versus 17.8 kcal/kg/day: p < 0.001) and proteins (1.11 versus 0.69 g/kg/day: p < 0.001) than the control group during the five days' intervention, resulting in a less negative energy balance by D9 (p = 0.0027). Net protein breakdown and Glucose kinetics on D9 did not differ, within or between groups. In agreement with a decrease in infection rate, immune response in the SPN group showed decreased serum IL-6 (p = 0.024), IL-1β, IL-10 levels and TNF-α secretion by PBMC (p = 0.018) at D9. Muscle mass loss from D4 to D15 tended to be less in the SPN group (-16% versus -23%: p = 0.06). Clinical course by D28 did not differ. CONCLUSIONS: Feeding patients to cover an individualised measured energy target with SPN from D4 to cover needs, was associated with improved immunity, less systemic inflammation and a trend to less muscle mass loss. CLINICAL TRIAL REGISTRY: NCT02022813 at https://clinicaltrials.gov/.
RCT Entities:
BACKGROUND & AIMS: Individualized supplemental parenteral nutrition (SPN) providing measured energy expenditure from day 4 reduced infectious complications in a previous study including 305 intensive care (ICU) patients. The study aimed at investigating the metabolic, and immune responses underlying the clinical response of the previous trial. METHODS: Randomized controlled trial enrolling 23 critically ill patients on day 3 (D3) of admission to the ICU who were fed less than 60% of their energy target by the enteral nutrition (EN) alone: allocation to either continued EN or to SPN to a target validated by indirect calorimetry. Protein and glucose metabolism (primary endpoint) were investigated with tracer isotopes on D4 and D9. Secondary endpoints: 1) immune response, investigated in serum and in stimulated peripheral blood mononuclear cells (PMBC), by dosing a panel of cytokines (infectious complications were recorded), and 2) Muscle mass was assessed by ultrasound of the thigh. RESULTS: Comparable at baseline, the SPN group (n = 11) received more energy (median 24.3 versus 17.8 kcal/kg/day: p < 0.001) and proteins (1.11 versus 0.69 g/kg/day: p < 0.001) than the control group during the five days' intervention, resulting in a less negative energy balance by D9 (p = 0.0027). Net protein breakdown and Glucose kinetics on D9 did not differ, within or between groups. In agreement with a decrease in infection rate, immune response in the SPN group showed decreased serum IL-6 (p = 0.024), IL-1β, IL-10 levels and TNF-α secretion by PBMC (p = 0.018) at D9. Muscle mass loss from D4 to D15 tended to be less in the SPN group (-16% versus -23%: p = 0.06). Clinical course by D28 did not differ. CONCLUSIONS: Feeding patients to cover an individualised measured energy target with SPN from D4 to cover needs, was associated with improved immunity, less systemic inflammation and a trend to less muscle mass loss. CLINICAL TRIAL REGISTRY: NCT02022813 at https://clinicaltrials.gov/.
Authors: Nicolaas E P Deutz; Pierre Singer; Raven A Wierzchowska-McNew; Marina V Viana; Itai A Ben-David; Olivier Pantet; John J Thaden; Gabriella A M Ten Have; Mariëlle P K J Engelen; Mette M Berger Journal: Clin Nutr Date: 2021-03-18 Impact factor: 7.324
Authors: Hanneke Pierre Franciscus Xaverius Moonen; Karin Josephina Hubertina Beckers; Arthur Raymond Hubert van Zanten Journal: J Intensive Care Date: 2021-01-12