One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial.
One year outcomes in patients with acute lung injury randomised to initial trophic or full enteral feeding: prospective follow-up of EDEN randomised trial.
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DOI：
10.1136/bmj.f1532
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发表时间：
2013-03-19
期刊：
影响因子：
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通讯作者：
NIH NHLBI ARDS Network
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文献类型：
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作者：
Needham DM;Dinglas VD;Bienvenu OJ;Colantuoni E;Wozniak AW;Rice TW;Hopkins RO;NIH NHLBI ARDS Network
目的评价初始低能量允许性营养不足（“营养性喂养”）与全能量肠内营养（“全喂养”）对急性肺损伤患者生理功能和继发结局的影响。研究设计：对NHLBI ARDS临床试验网络的EDEN试验进行前瞻性纵向随访评价，该试验在美国41家医院进行。研究对象525例急性肺损伤患者。干预措施随机分配至营养或完全喂养，持续6天;此后，所有仍接受机械通气的患者均接受完全喂养。急性肺损伤后12个月时SF-36仪器的年龄和性别调整的身体功能领域的盲态评估。次要结果指标包括生存率;生理、心理和认知功能;生活质量;以及6个月和12个月时的就业状况。结果急性肺损伤后，患者有实质性的身体、心理和认知障碍，生活质量下降，重返工作岗位受损。初始营养与完全喂养不影响12个月时的平均SF-36身体功能（55（SD 33）v 55（31），P=0.54），12个月生存率（65% v 63%，P=0.63）或几乎所有次要结局。结论在急性肺损伤的幸存者中，初始营养或完全肠内喂养后6个月和12个月随访时的身体功能、生存率或多个次要结局无差异。试验注册NCT编号00719446
Objective To evaluate the effect of initial low energy permissive underfeeding (“trophic feeding”) versus full energy enteral feeding (“full feeding”) on physical function and secondary outcomes in patients with acute lung injury. Design Prospective longitudinal follow-up evaluation of the NHLBI ARDS Clinical Trials Network’s EDEN trial Setting 41hospitals in the United States. Participants 525 patients with acute lung injury. Interventions Randomised assignment to trophic or full feeding for up to six days; thereafter, all patients still receiving mechanical ventilation received full feeding. Measurements Blinded assessment of the age and sex adjusted physical function domain of the SF-36 instrument at 12 months after acute lung injury. Secondary outcome measures included survival; physical, psychological, and cognitive functioning; quality of life; and employment status at six and 12 months. Results After acute lung injury, patients had substantial physical, psychological, and cognitive impairments, reduced quality of life, and impaired return to work. Initial trophic versus full feeding did not affect mean SF-36 physical function at 12 months (55 (SD 33) v 55 (31), P=0.54), survival to 12 months (65% v 63%, P=0.63), or nearly all of the secondary outcomes. Conclusion In survivors of acute lung injury, there was no difference in physical function, survival, or multiple secondary outcomes at 6 and 12 month follow-up after initial trophic or full enteral feeding. Trial Registration NCT No 00719446