Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial.
Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial.
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DOI：
10.1001/jama.2012.137
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发表时间：
2012-02-22
影响因子：
120.7
通讯作者：
Rock, Peter
中科院分区：
文献类型：
--
作者：
Rice, Todd W.;Wheeler, Arthur P.;Thompson, B. Taylor;Steingrub, Jay;Hite, R. Duncan;Moss, Marc;Morris, Alan;Dong, Ning;Rock, Peter
急性肺损伤患者需要多少肠内营养尚不清楚。确定与初始全肠内喂养相比，初始低容量营养肠内喂养是否会增加无呼吸机天数并减少胃肠道不耐受。EDEN研究是从2008年1月2日至2011年4月12日进行的一项随机、开放标签、多中心试验。参与者是1000名发生急性肺损伤需要机械通气的48小时内的成年人，他们的医生打算在国家心肺血液研究所ARDS临床试验网络的44家医院开始肠内营养。参与者在前6天随机接受营养喂养或完全肠内喂养。第6天之后，所有仍在接受机械通气的患者按照全喂养方案进行护理。无呼吸机天数为学习第28天。营养饲养组（n=508）和全饲组（n=492）的基线特征相似。全饲组前6 d肠内热量摄入较多，前者约为1300 kcal/d，后者为400 kcal/d （P< 0.001）。与完全喂养相比，初始营养喂养并未增加无呼吸机天数（14.9 [95% CI， 13.9至15.8]vs 15.0 [95% CI， 14.1至15.9]；差异为- 0.1 [95% CI, - 1.4至1.2]；P= 0.89）或降低60天死亡率（23.2% [95% CI， 19.6%至26.9%]vs 22.2% [95% CI， 18.5%至25.8%]；差异为1.0% [95% CI, - 4.1%至6.3%]；P=77）。两组间感染并发症发生率无差异。尽管使用了更多的促动力药物，但全饲组出现了更多的呕吐（2.2%对1.7%的患者喂养日，P= 0.05）、胃残余体积增加（4.9%对2.2%的患者喂养日，P< 0.001）和便秘（3.1%对2.1%的患者喂养日，P= 0.003）。在前6天，全饲组的平均血糖值和平均每小时胰岛素给药量均较高。在急性肺损伤患者中，与完全肠内喂养相比，初始营养肠内喂养长达6天的策略并没有改善无呼吸机天数、60天死亡率或感染并发症，但与胃肠道不耐受减少有关。
The amount of enteral nutrition patients with acute lung injury need is unknown. To determine if initial lower-volume trophic enteral feeding would increase ventilator-free days and decrease gastrointestinal intolerances compared with initial full enteral feeding. The EDEN study, a randomized, open-label, multicenter trial conducted from January 2, 2008, through April 12, 2011. Participants were 1000 adults within 48 hours of developing acute lung injury requiring mechanical ventilation whose physicians intended to start enteral nutrition at 44 hospitals in the National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Participants were randomized to receive either trophic or full enteral feeding for the first 6 days. After day 6, the care of all patients who were still receiving mechanical ventilation was managed according to the full feeding protocol. Ventilator-free days to study day 28. Baseline characteristics were similar between the trophic-feeding (n=508) and full-feeding (n=492) groups. The full-feeding group received more enteral calories for the first 6 days, about 1300 kcal/d compared with 400 kcal/d (P<.001). Initial trophic feeding did not increase the number of ventilator-free days (14.9 [95% CI, 13.9 to 15.8] vs 15.0 [95% CI, 14.1 to 15.9]; difference, −0.1 [95% CI, −1.4 to 1.2]; P=.89) or reduce 60-day mortality (23.2% [95% CI, 19.6% to 26.9%] vs 22.2% [95% CI, 18.5% to 25.8%]; difference, 1.0% [95% CI, −4.1% to 6.3%]; P=77) compared with full feeding. There were no differences in infectious complications between the groups. Despite receiving more prokinetic agents, the full-feeding group experienced more vomiting (2.2% vs 1.7% of patient feeding days; P=.05), elevated gastric residual volumes (4.9% vs 2.2% of feeding days; P<.001), and constipation (3.1% vs 2.1% of feeding days; P=.003). Mean plasma glucose values and average hourly insulin administration were both higher in the full-feeding group over the first 6 days. In patients with acute lung injury, compared with full enteral feeding, a strategy of initial trophic enteral feeding for up to 6 days did not improve ventilator-free days, 60-day mortality, or infectious complications but was associated with less gastrointestinal intolerance.
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