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Outcomes Six-Months After 100% or 70% of Enteral Calorie Requirements During Critical Illness (TARGET): A Randomized Controlled Trial.

危重病期间肠内热量需求 100% 或 70% 后 6 个月的结局 (目标): 一项随机对照试验。

  • 影响因子:5.24
  • DOI:10.1164/rccm.201909-1810OC
  • 作者列表:"Deane AM","Little L","Bellomo R","Chapman MJ","Davies AR","Ferrie S","Horowitz M","Hurford S","Lange K","Litton E","Mackle D","O'Connor S","Parker J","Peake SL","Presneill JJ","Ridley EJ","Singh V","van Haren F","Williams P","Young P","Iwashyna TJ","TARGET Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group.
  • 发表时间:2020-01-06
Abstract

RATIONALE:The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared to a lesser amount of calories are unknown. OBJECTIVES:Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality of life scores, return to work and key life activities and reduce death and disability six months later. METHODS:We conducted a multicenter, blinded, parallel group, randomized clinical trial, with 3957 mechanically ventilated critically ill adults allocated to energy-dense (1.5 kcal/ml) or routine (1.0 kcal/ml) enteral nutrition. MEASUREMENTS AND MAIN RESULTS:Participants assigned energy-dense nutrition received more calories (% recommended energy intake, mean (SD) (energy-dense: 103% (28) vs. usual: 69% (18)). Mortality at day-180 was similar (560/1895 (29.6%) vs. 539/1920 (28.1%); relative risk 1.05 (95%CI, 0.95 to 1.16)). At a median [IQR] of 185 [182, 193] days after randomization, 2492 survivors were surveyed and reported similar quality of life (EuroQol five dimensions five-level quality of life questionnaire visual analogue scale, median [IQR]: 75 [60-85]; group difference: 0 (95%CI, 0 to 0)). Similar numbers of participants returned to work with no difference in hours worked or effectiveness at work (n=818). There was no observed difference in disability (n=1208) or participation in key life activities (n=705). CONCLUSIONS:The delivery of approximately 100% compared to 70% of recommended calorie intake during critical illness does not improve quality of life, or functional outcomes, or increase the number of survivors six months later. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02306746.

摘要

理由: 与较少的卡路里量相比,在危重疾病期间通过肠内途径提供约 100% 的推荐卡路里摄入量的长期影响尚不清楚。 目的: 我们的假设是,在危重病期间达到推荐卡路里摄入量的大约 100% 将增加生活质量评分,恢复工作和关键生活活动,并减少 6 个月后的死亡和残疾。 方法: 我们进行了一项多中心、盲法、平行组、随机临床试验,将 3957 名机械通气的危重成人分配到能量密集 (1.5 kcal/ml) 或常规 (1.0 kcal/ml) 肠内营养。 测量和主要结果: 分配能量密集营养的参与者获得了更多的卡路里 (% 推荐能量摄入,平均值 (SD) (能量密集: 103% (28) vs.通常: 69% (18))。180 天的死亡率相似 (560/1895 (29.6%) vs.539/1920 (28.1%); 相对风险 1.05 (95% CI,0.95-1.16))。在随机分组后中位数 [IQR] 为 185 [182,193] 天, 对 2492 名存活者进行了调查,并报告了相似的生活质量 (EuroQol 五个维度五级生活质量问卷视觉模拟量表,中位数 [IQR]: 75 [60-85]; 组间差异: 0 (95% CI,0 到 0))。相似数量的参与者返回工作,工作时间或工作效率没有差异 (n = 818)。在残疾 (n = 1208) 或参与关键生命活动 (n = 705) 方面没有观察到差异。 结论: 在危重病期间,与推荐卡路里摄入量的 100% 相比,分娩约 70% 不会改善生活质量或功能结局,也不会增加 6 个月后的幸存者人数。临床试验注册可在 www.clinicaltrials.gov,ID: nct02306746。

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影响因子:3.31
发表时间:2020-01-06
来源期刊:Critical care medicine
DOI:10.1097/CCM.0000000000004176
作者列表:["Heyland DK","Marquis F","Lamontagne F","Albert M","Turgeon AF","Khwaja KA","Garland A","Hall R","Chapman MG","Kutsiogannis DJ","Martin C","Sessler DI","Day AG"]

METHODS:OBJECTIVES:To evaluate the effect of esophageal stimulation on nutritional adequacy in critically ill patients at risk for enteral feeding intolerance. DESIGN:A multicenter randomized sham-controlled clinical trial. SETTING:Twelve ICUs in Canada. PATIENTS:We included mechanically ventilated ICU patients who were given moderate-to-high doses of opioids and expected to remain alive and ventilated for an additional 48 hours and who were receiving enteral nutrition or expected to start imminently. INTERVENTIONS:Patients were randomly assigned 1:1 to esophageal stimulation via an esophageal stimulating catheter (E-Motion Tube; E-Motion Medical, Tel Aviv, Israel) or sham treatment. All patients were fed via these catheters using a standardized feeding protocol. MEASUREMENTS AND MAIN RESULTS:The co-primary outcomes were proportion of caloric and protein prescription received enterally over the initial 7 days following randomization. Among 159 patients randomized, the modified intention-to-treat analysis included 155 patients: 73 patients in the active treatment group and 82 in the sham treatment group. Over the 7-day study period, the percent of prescribed caloric intake (± SE) received by the enteral route was 64% ± 2 in the active group and 65% ± 2 in sham patients for calories (difference, -1; 95% CI, -8 to 6; p = 0.74). For protein, it was 57% ± 3 in the active group and 60% ± 3 in the sham group (difference, -3; 95% CI, -10 to 3; p = 0.30). Compared to the sham group, there were more serious adverse events reported in the active treatment group (13 vs 6; p = 0.053). Clinically important arrhythmias were detected by Holter monitoring in 36 out of 70 (51%) in the active group versus 22 out of 76 (29%) in the sham group (p = 0.006). CONCLUSIONS:Esophageal stimulation via a special feeding catheter did not improve nutritional adequacy and was associated with increase risk of harm in critically ill patients.

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翻译标题与摘要 下载文献
影响因子:5.24
发表时间:2020-01-06
DOI:10.1164/rccm.201909-1810OC
作者列表:["Deane AM","Little L","Bellomo R","Chapman MJ","Davies AR","Ferrie S","Horowitz M","Hurford S","Lange K","Litton E","Mackle D","O'Connor S","Parker J","Peake SL","Presneill JJ","Ridley EJ","Singh V","van Haren F","Williams P","Young P","Iwashyna TJ","TARGET Investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group."]

METHODS:RATIONALE:The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared to a lesser amount of calories are unknown. OBJECTIVES:Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality of life scores, return to work and key life activities and reduce death and disability six months later. METHODS:We conducted a multicenter, blinded, parallel group, randomized clinical trial, with 3957 mechanically ventilated critically ill adults allocated to energy-dense (1.5 kcal/ml) or routine (1.0 kcal/ml) enteral nutrition. MEASUREMENTS AND MAIN RESULTS:Participants assigned energy-dense nutrition received more calories (% recommended energy intake, mean (SD) (energy-dense: 103% (28) vs. usual: 69% (18)). Mortality at day-180 was similar (560/1895 (29.6%) vs. 539/1920 (28.1%); relative risk 1.05 (95%CI, 0.95 to 1.16)). At a median [IQR] of 185 [182, 193] days after randomization, 2492 survivors were surveyed and reported similar quality of life (EuroQol five dimensions five-level quality of life questionnaire visual analogue scale, median [IQR]: 75 [60-85]; group difference: 0 (95%CI, 0 to 0)). Similar numbers of participants returned to work with no difference in hours worked or effectiveness at work (n=818). There was no observed difference in disability (n=1208) or participation in key life activities (n=705). CONCLUSIONS:The delivery of approximately 100% compared to 70% of recommended calorie intake during critical illness does not improve quality of life, or functional outcomes, or increase the number of survivors six months later. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02306746.

翻译标题与摘要 下载文献
影响因子:1.21
发表时间:2020-01-07
DOI:10.1097/SLE.0000000000000754
作者列表:["Tan JH","Sivadurai G","Tan HCL","Tan YR","Jahit S","Hans Alexander M"]

METHODS:BACKGROUND:Provision of enteral nutrition with jejunal feeding in upper gastrointestinal obstruction is highly recommended. Access to jejunum can be obtained surgically, percutaneously, or endoscopically. Our institution routinely and preferentially utilizes a silicone nasojejunal tube that is inserted past the obstruction endoscopically. We use a custom dual channel tube that allows feeding at the distal tip and another channel 40 cm from the tip that enables decompression proximally. This is a report of our experience with this custom nasojejunal tube. METHODS:This is a prospective observational study of 201 patients who underwent endoscopic nasojejunal wire-guided feeding tube insertions for obstruction of either the esophagus or the stomach including both benign and malignant pathologies between January 2015 to June 2018 in Hospital Sungai Buloh and Hospital Sultanah Aminah, Malaysia. The indications for tube insertion, insertion technique, and tube-related problems were described. RESULTS:The nasojejunal tube was used to establish enteral feeding in patients with obstructing tumors of the distal esophagus in 65 patients (32.3%) and gastric outlet obstruction in 72 patients (35.8%). There were 54 patients (26.9%) who required reinsertion. The most common reason for reinsertion was unintentional dislodgement, where 32 patients (15.9%) followed by tube blockage 20 patients (10.0%). Using our method of advancement under direct vision, we had only 2 cases of malposition due to severely deformed anatomy. We had no incidence of aspiration in this group of patients and overall, the patients tolerated the tube well. CONCLUSIONS:The novel nasojejunal feeding tube with gastric decompression function is a safe and effective method of delivery of enteral nutrition in patients with upper gastrointestinal obstruction. These tubes if inserted properly are well tolerated with almost no risk of malposition and are tolerated well even for prolonged periods of time until definitive surgery could be performed.

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