Title :

Impact of nutrition route on microaspiration in critically ill patients with shock: a planned ancillary study of the nutrirea-2 trial

Author(s) :

Nseir, Saad [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Université de Lille
Le Gouge, Amelie [Auteur]
Lascarrou, Jean-Baptiste [Auteur]
Lacherade, Jean-Claude [Auteur]
Jaillette, Emmanuelle [Auteur]
Mira, Jean-Paul [Auteur]
Mercier, Emmanuelle [Auteur]
Declercq, Pierre-Louis [Auteur]
Sirodot, Michel [Auteur]
Piton, Gaël [Auteur]
Tinturier, François [Auteur]
Coupez, Elisabeth [Auteur]
Gaudry, Stéphane [Auteur]
Djibré, Michel [Auteur]
Thevenin, Didier [Auteur]
Pasco, Jeremy [Auteur]
Balduyck, Malika [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Université de Lille
Zerimech, Farid [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Reignier, Jean [Auteur]

Journal title :

Critical Care

Abbreviated title :

Crit Care

Volume number :

23

Pages :

111

Publisher :

BioMed Central

Publication date :

2019-04-05

ISSN :

1466-609X

English keyword(s) :

Pneumonia
Critical care
Pathophysiology
Microaspiration
Gastric contents
Oropharyngeal secretions

HAL domain(s) :

Sciences du Vivant [q-bio]
Sciences du Vivant [q-bio]/Santé publique et épidémiologie
Sciences du Vivant [q-bio]/Alimentation et Nutrition

English abstract : [en]

BACKGROUND: Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine ...
Show more >BACKGROUND: Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions. METHODS: Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial. Patients with shock receiving invasive mechanical ventilation were randomized to receive early enteral or parenteral nutrition. All tracheal aspirates were collected during the 48 h following randomization. Abundant microaspiration of gastric contents and oropharyngeal secretions was defined as the presence of significant levels of pepsin (> 200 ng/ml) and salivary amylase (> 1685 UI/ml) in > 30% of tracheal aspirates. RESULTS: A total of 151 patients were included (78 and 73 patients in enteral and parenteral nutrition groups, respectively), and 1074 tracheal aspirates were quantitatively analyzed for pepsin and amylase. Although vomiting rate was significantly higher (31% vs 15%, p = 0.016), constipation rate was significantly lower (6% vs 21%, p = 0.010) in patients with enteral than in patients with parenteral nutrition. No significant difference was found regarding other patient characteristics. The percentage of patients with abundant microaspiration of gastric contents was significantly lower in enteral than in parenteral nutrition groups (14% vs 36%, p = 0.004; unadjusted OR 0.80 (95% CI 0.69, 0.93), adjusted OR 0.79 (0.76, 0.94)). The percentage of patients with abundant microaspiration of oropharyngeal secretions was significantly higher in enteral than in parenteral nutrition groups (74% vs 54%, p = 0.026; unadjusted OR 1.21 (95% CI 1.03, 1.44), adjusted OR 1.23 (1.01, 1.48)). No significant difference was found in percentage of patients with ventilator-associated pneumonia between enteral (8%) and parenteral (10%) nutrition groups (HR 0.78 (0.26, 2.28)). CONCLUSIONS: Our results suggest that enteral and parenteral nutrition are associated with high rates of microaspiration, although oropharyngeal microaspiration was more common with enteral nutrition and gastric microaspiration was more common with parenteral nutrition.Show less >

Language :

Anglais

Peer reviewed article :

Oui

Audience :

Internationale

Popular science :

Non

Other project(s) or funding source(s) :

French Ministry of Health, PHRCN-12-0184

Administrative institution(s) :

CHU Lille
Institut Pasteur de Lille
Université de Lille

Collections :

• Autres travaux scientifiques

Submission date :

2022-02-02T10:23:55Z
2024-02-20T14:47:10Z
2024-02-20T14:48:53Z