Enteral nutrition is associated with improved outcome in patients with severe sepsis: A secondary analysis of the VISEP trial

• Published in: Medizinische Klinik, Intensivmedizin und Notfallmedizin Intensivmedizin und Notfallmedizin, 2013-04, Vol.108 (3), p.223-233
• Main Authors: Elke, G., Kuhnt, E., Ragaller, M., Schädler, D., Frerichs, I., Brunkhorst, F.M., Löffler, M., Reinhart, K., Weiler, N.
• Format: Article
• Language: English
• Subjects: Abdomen - surgery; Aged; APACHE; Combined Modality Therapy; Critical Care; Critical Care Medicine; Emergency Medicine; Energy Intake; Enteral Nutrition; Female; Gastrointestinal Diseases - surgery; Germany; Humans; Hydroxyethyl Starch Derivatives - therapeutic use; Insulin - therapeutic use; Intensive; Intensive Care Units; Internal Medicine; Length of Stay; Male; Medicine; Medicine & Public Health; Middle Aged; Originalien; Parenteral Nutrition, Total; Plasma Substitutes; Postoperative Complications - therapy; Proportional Hazards Models; Prospective Studies; Renal Replacement Therapy; Respiration, Artificial; Sepsis - mortality; Sepsis - therapy; Shock, Septic - mortality; Shock, Septic - therapy; Survival Rate
• ISSN: 2193-6218; 2193-6226
• DOI: 10.1007/s00063-013-0224-4

Introduction The optimal nutritional strategy remains controversial, particularly in severely septic patients. Our aim was to analyze the effect of three nutritional strategies—enteral (EN), parenteral (PN), and combined nutrition (EN+PN)—on the outcome of patients with severe sepsis or septic shock. Patients and methods This secondary analysis of the prospective, randomized–controlled, multicenter “Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis (VISEP)” trial only included patients with a length of stay in the intensive care unit (ICU) of more than 7 days. Besides patient characteristics, data on nutrition therapy were collected daily for up to 21 days. Morbidity as measured by the mean Sequential Organ Failure Assessment (SOFA) score, incidence of secondary infections, renal replacement therapy, ventilator-free days and severe hypoglycemia, length of ICU stay, and mortality at 90 days were compared between the three nutritional strategies. Results In all, 353 patients were included in the analysis with the majority (68.5 %) receiving EN+PN, 24.4 % receiving EN, and only 7.1 % receiving PN. Median caloric intake was 918 kcal/day (EN), 1,210 kcal/day (PN), and 1,343 kcal/day (EN+PN; p