Physical and Cognitive Performance of Patients with Acute Lung Injury 1 Year after Initial Trophic versus Full Enteral Feeding EDEN Trial Follow-up
Physical and Cognitive Performance of Patients with Acute Lung Injury 1 Year after Initial Trophic versus Full Enteral Feeding EDEN Trial Follow-up
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DOI：
10.1164/rccm.201304-0651oc
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发表时间：
2013-09-01
影响因子：
24.7
通讯作者：
Hopkins, Ramona O.
中科院分区：
文献类型：
--
作者：
Needham, Dale M.;Dinglas, Victor D.;Hopkins, Ramona O.
基本原理：我们假设，在重症监护室为急性肺损伤患者提供两种不同的蛋白质/热量营养策略可能会影响长期的身体和认知能力。目的：评估急性肺损伤后6个月和12个月的身体和认知能力，并评价营养与完全肠道喂养的效果，在机械通气的前6天提供，方法：一项前瞻性纵向辅助研究，对12个中心中的5个中心的174名连续幸存者进行评估。对患者手臂人体测量、力量、肺功能、6分钟步行距离和认知状态进行盲法评估（执行功能、语言、记忆、言语推理/概念形成和注意力）。测量和主要结果：在6个月和12个月时，6分钟步行距离的平均（SD）预测百分比分别为64%（22%）和66%（25%）。（评估之间的差异P = 0.011），36%和25%的幸存者有认知障碍（P - 0.001）。患者的二次体格检查低于预测值，从6个月到12个月略有改善。在随机分组后的前6天，初始营养与完全喂养对幸存者6分钟步行距离、认知障碍状态和所有次要结局的预测百分比没有显著影响。结论：EDEN试验幸存者在6个月和12个月时的身体和认知表现低于预测值，随着时间的推移，[GRAPHICS]有所改善。在随机化后的前6天，初始营养与完全肠内喂养对身体和认知能力没有影响。
Rationale: We hypothesized that providing patients with acute lung injury two different protein/calorie nutritional strategies in the intensive care unit may affect longer-term physical and cognitive performance.Objectives: To assess physical and cognitive performance 6 and 12 months after acute lung injury, and to evaluate the effect of trophic versus full enteral feeding, provided for the first 6 days of mechanical ventilation, on 6-minute-walk distance, cognitive impairment, and secondary outcomes.Methods: A prospective, longitudinal ancillary study of the ARDS Network EDEN trial evaluating 174 consecutive survivors from 5 of 12 centers. Blinded assessments of patients' arm anthropometrics, strength, pulmonary function, 6-minute-walk distance, andcognitive status (executive function, language, memory, verbal reasoning/concept formation, and attention) were performed.Measurements and Main Results: At 6 and 12 months, respectively, the mean (SD) percent predicted for 6-minute-walk distance was 64%(22%) and66%(25%)(P = 0.011 for difference between assessments), and 36 and 25% of survivors had cognitive impairment (P - 0.001). Patients performed below predicted values for secondary physical tests with small improvement from 6 to 12 months. There was no significant effect of initial trophic versus full feeding for the first 6 days after randomization on survivors' percent predicted for 6-minute walk distance, cognitive impairment status, and all secondary outcomes.Conclusions: EDEN trial survivors performed below predicted values for physical and cognitive performance at 6 and 12 months, with[GRAPHICS]some improvement over time. Initial trophic versus full enteral feeding for the first 6 days after randomization did not affect physical and cognitive performance.