Role of Disease and Macronutrient Dose in the Randomized Controlled EPaNIC Trial A Post Hoc Analysis
Role of Disease and Macronutrient Dose in the Randomized Controlled EPaNIC Trial A Post Hoc Analysis
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DOI：
10.1164/rccm.201206-0999oc
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发表时间：
2013-02-01
影响因子：
24.7
通讯作者：
Van den Berghe, Greet
中科院分区：
文献类型：
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作者：
Casaer, Michael P.;Wilmer, Alexander;Van den Berghe, Greet
理由：与停止肠外营养 1 周（晚期 PN）相比，在重症监护期间早期肠外营养（早期 PN）补充肠内喂养不足会延迟恢复。目的：评估早期 PN 的有害影响是否与疾病的严重程度或大量营养素的剂量或类型有关。方法：对在两家比利时医院三个科室的 7 个重症监护病房进行的随机对照试验 (EPaNIC；n = 4,640) 进行的二次分析。第 1 部分中，纳入了所有患者，以评估随机分配到早期 PN 或晚期 PN 的效果，这些患者亚组的入院时病情严重程度不断增加。在第 2 部分中，观察性地记录了第 3、5、7、10 和 14 天仍在重症监护室的患者队列中大量营养素的数量和类型与恢复的关系。测量和主要结果：主要终点是从重症监护室出院的时间。第 1 部分还分析了次要终点，即新感染的发生。所有统计分析均通过单变量和调整的多变量方法进行。在按疾病类型或严重程度定义的亚组中，均未观察到早期 PN 的有益作用。常量营养素的最低剂量与最快的恢复相关，而任何较高剂量（肠外或肠内给药）则与恢复逐渐延迟相关。蛋白质/氨基酸的量而不是葡萄糖的量似乎可以解释早期喂养延迟恢复的原因。结论：无论危重疾病的严重程度如何，早期联合肠外/肠内营养都会延迟恢复。没有发现常量营养素的剂量或类型与改善结果相关。临床试验已在 www.clinicaltrials.gov 注册（NCT 00512122）。
Rationale: Early parenteral nutrition to supplement insufficient enteral feeding during intensive care (early PN) delays recovery as compared with withholding parenteral nutrition for 1 week (late PN).Objectives: To assess whether deleterious effects of early PN relate to severity of illness or to the dose or type of macronutrients.Methods: Secondary analyses of a randomized controlled trial (EPaNIC; n = 4,640) performed in seven intensive care units from three departments in two Belgian hospitals. In part 1, all patients were included to assess the effect of the randomized allocation to early PN or late PN in subgroups of patients with increasing-on-admission severity of illness. In part 2, observationally, the association of the amount and type of macronutrients with recovery was documented in those patient cohorts still present in intensive care on Days 3, 5, 7, 10, and 14.Measurements and Main Results: The primary end point was time to live discharge from the intensive care unit. For part 1, a secondary end point, acquisition of new infections, was also analyzed. All statistical analyses were performed by univariable and adjusted multi-variable methods. In none of the subgroups defined by type or severity of illness was a beneficial effect of early PN observed. The lowest dose of macronutrients was associated with the fastest recovery and any higher dose, administered parenterally or enterally, was associated with progressively more delayed recovery. The amount of proteins/amino acids rather than of glucose appeared to explain delayed recovery with early feeding.Conclusions: Early combined parenteral/enteral nutrition delayed recovery irrespective of severity of critical illness. No dose or type of macronutrient was found to be associated with improved outcome. Clinical trial registered with www.clinicaltrials.gov (NCT 00512122).