Tolerability and efficacy of a low-volume enteral supplement containing key nutrients in the critically ill

• Published in: Clinical nutrition (Edinburgh, Scotland) Scotland), 2011-10, Vol.30 (5), p.599-603
• Main Authors: Schneider, Andrea, Markowski, Andrea, Momma, Michael, Seipt, Claudia, Luettig, Birgit, Hadem, Johannes, Wilhelmi, Michaela, Manns, Michael P, Wedemeyer, Jochen
• Format: Article
• Language: English
• Subjects: Adult; antibiotics; Antioxidants; Antioxidants - administration & dosage; Antioxidants - adverse effects; Antioxidants - therapeutic use; Biological and medical sciences; Critical Illness; Critically ill; death; diet; Early feeding; energy; Energy Intake; Enteral nutrition; Enteral Nutrition - adverse effects; Feeding. Feeding behavior; Female; fever; Fever - complications; Fever - etiology; Fever - prevention & control; Food, Formulated - adverse effects; Food, Formulated - analysis; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; glutamine; Glutamine - administration & dosage; Glutamine - adverse effects; Glutamine - therapeutic use; hospitals; Humans; Intensive Care Units; Length of Stay; Male; males; Middle Aged; Nutrient; nutrients; patients; Pilot Projects; selenium; Selenium - administration & dosage; Sepsis; Sepsis - complications; Sepsis - physiopathology; Sepsis - therapy; Single-Blind Method; Systemic Inflammatory Response Syndrome - complications; Systemic Inflammatory Response Syndrome - physiopathology; Systemic Inflammatory Response Syndrome - therapy; Vertebrates: anatomy and physiology, studies on body, several organs or systems; vitamin E; Vitamin E - administration & dosage
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2011.04.003

Summary Background & aims To compare early supplementation with antioxidants and glutamine using a low-volume enteral supplement containing key nutrients to an energy adjusted standard elementary diet and to investigate its effect on clinical efficacy and tolerability in critically ill patients with sepsis/SIRS. The primary endpoints were length of stay in the ICU and sufficient enteral feed. Methods This was a randomized, prospective, single-blind, controlled study in 58 critically ill patients (56.9% male, mean age 46.7 years, mean APACHE II score 21.6). They received either a low-volume enteral supplement containing key nutrients or a diluted standard nutrition solution. After 10 or 14 days inflammatory parameters, catecholamine need, and maximal enteral delivery were determined. Results Patients receiving a low-volume enteral supplement containing key nutrients did not reach sufficient enteral feed more often than controls (76 vs. 62%, respectively, p  = 0.17). The difference in vitamin E and selenium uptake was higher in the treatment group than controls (12.4 vs. 3.7 and 54.7 vs. 16.3, respectively, p  ≤ 0.011). Parameters such as fever, antibiotic treatment, artificial ventilation, and death were comparable. This was also true for days of ICU or hospital stay (33 ± 23 and 49 ± 34 days, respectively). Conclusions The low-volume enteral supplement containing key nutrients was well tolerated and led to a better vitamin E and selenium supply. However, it did not affect length of ICU or hospital stay. Further studies are necessary to determine which disease-specific subgroups may benefit from this supplementation or which group may be harmed.