Titre :

Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)

Auteur(s) :

Reignier, Jean [Auteur]
Université de Nantes [UN]
Boisrame-Helms, Julie [Auteur]
Université de Strasbourg [UNISTRA]
Brisard, Laurent [Auteur]
Lascarrou, Jean-Baptiste [Auteur]
Université de Nantes [UN]
Hssain Ali, Ait [Auteur]
Anguel, Nadia [Auteur]
Arnaud, Laurent [Auteur]
Asehnoune, Karim [Auteur]
Université de Nantes [UN]
Asfar, Pierre [Auteur]
Université d'Angers [UA]
Bellec, Frederic [Auteur]
Botoc, Vlad [Auteur]
Bretagnol, Anne [Auteur]
Bui, Hoang-Nam [Auteur]
Canet, Emmanuel [Auteur]
Da Silva, Daniel [Auteur]
Darmon, Michael [Auteur]
Das, Vincent [Auteur]
Devaquet, Jerome [Auteur]
Djibre, Michel [Auteur]
Ganster, Frederique [Auteur]
Garrouste-Orgeas, Maite [Auteur]
Université Paris Diderot, Sorbonne Paris Cité, Paris, France
Gaudry, Stephane [Auteur]
Université Paris Diderot, Sorbonne Paris Cité, Paris, France
Gontier, Olivier [Auteur]
Guerin, Claude [Auteur]
Université Claude Bernard Lyon 1 [UCBL]
Guidet, Bertrand [Auteur]
Université Pierre et Marie Curie - Paris 6 [UPMC]
Guitton, Christophe [Auteur]
Herbrecht, Jean-Etienne [Auteur]
Université de Strasbourg [UNISTRA]
Lacherade, Jean-Claude [Auteur]
Letocart, Philippe [Auteur]
Martino, Frederic [Auteur]
Maxime, Virginie [Auteur]
Mercier, Emmanuelle [Auteur]
Mira, Jean-Paul [Auteur]
Nseir, Saad [Auteur]
Lille Inflammation Research International Center (LIRIC) - U995
Lille Inflammation Research International Center - U 995 [LIRIC]
Piton, Gael [Auteur]
Université de Franche-Comté [UFC]
Quenot, Jean-Pierre [Auteur]
Université de Bourgogne [UB]
Richecoeur, Jack [Auteur]
Rigaud, Jean-Philippe [Auteur]
Robert, Rene [Auteur]
Université de Poitiers = University of Poitiers [UP]
Rolin, Nathalie [Auteur]
Schwebel, Carole [Auteur]
Université Grenoble Alpes [2016-2019] [UGA [2016-2019]]
Sirodot, Michel [Auteur]
Tinturier, Francois [Auteur]
Thevenin, Didier [Auteur]
Giraudeau, Bruno [Auteur]
Université de Tours [UT]
Le Gouge, Amelie [Auteur]
Université de Tours [UT]
Favory, Raphael [Auteur]
Lille Inflammation Research International Center (LIRIC) - U995
Facteurs de Risque et Déterminants Moléculaires des Maladies liées au Vieillissement - U 1167 [RID-AGE]

Titre de la revue :

The Lancet

Nom court de la revue :

Lancet

Numéro :

391

Pagination :

133-143

Date de publication :

2018-01-13

Discipline(s) HAL :

Sciences du Vivant [q-bio]

Résumé en anglais : [en]

Background: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early ...
Lire la suite >Background: Whether the route of early feeding affects outcomes of patients with severe critical illnesses is controversial. We hypothesised that outcomes were better with early first-line enteral nutrition than with early first-line parenteral nutrition. Methods: In this randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2 trial) done at 44 French intensive-care units (ICUs), adults (18 years or older) receiving invasive mechanical ventilation and vasopressor support for shock were randomly assigned (1:1) to either parenteral nutrition or enteral nutrition, both targeting normocaloric goals (20–25 kcal/kg per day), within 24 h after intubation. Randomisation was stratified by centre using permutation blocks of variable sizes. Given that route of nutrition cannot be masked, blinding of the physicians and nurses was not feasible. Patients receiving parenteral nutrition could be switched to enteral nutrition after at least 72 h in the event of shock resolution (no vasopressor support for 24 consecutive hours and arterial lactate <2 mmol/L). The primary endpoint was mortality on day 28 after randomisation in the intention-to-treat-population. This study is registered with ClinicalTrials.gov, number NCT01802099. Findings: After the second interim analysis, the independent Data Safety and Monitoring Board deemed that completing patient enrolment was unlikely to significantly change the results of the trial and recommended stopping patient recruitment. Between March 22, 2013, and June 30, 2015, 2410 patients were enrolled and randomly assigned; 1202 to the enteral group and 1208 to the parenteral group. By day 28, 443 (37%) of 1202 patients in the enteral group and 422 (35%) of 1208 patients in the parenteral group had died (absolute difference estimate 2·0%; [95% CI −1·9 to 5·8]; p=0·33). Cumulative incidence of patients with ICU-acquired infections did not differ between the enteral group (173 [14%]) and the parenteral group (194 [16%]; hazard ratio [HR] 0·89 [95% CI 0·72–1·09]; p=0·25). Compared with the parenteral group, the enteral group had higher cumulative incidences of patients with vomiting (406 [34%] vs 246 [20%]; HR 1·89 [1·62–2·20]; p<0·0001), diarrhoea (432 [36%] vs 393 [33%]; 1·20 [1·05–1·37]; p=0·009), bowel ischaemia (19 [2%] vs five [<1%]; 3·84 [1·43–10·3]; p=0·007), and acute colonic pseudo-obstruction (11 [1%] vs three [<1%]; 3·7 [1·03–13·2; p=0·04). Interpretation: In critically ill adults with shock, early isocaloric enteral nutrition did not reduce mortality or the risk of secondary infections but was associated with a greater risk of digestive complications compared with early isocaloric parenteral nutrition.Lire moins >

Langue :

Anglais

Audience :

Internationale

Vulgarisation :

Non

Établissement(s) :

Inserm
Université de Lille
CHU Lille

Collections :

• Facteurs de risque et déterminants moléculaires des maladies liées au vieillissement (RID-AGE) - U1167
• Institut de Recherche Translationnelle sur l'Inflammation (INFINITE) - U1286

Équipe(s) de recherche :

Fungal associated invasive and inflammatory diseases
Glycation from inflammation to aging

Date de dépôt :

2019-03-01T14:26:48Z
2024-01-29T15:15:44Z