Early and Adequate Protein Feeding Post-Traumatic Injury

创伤后早期和充足的蛋白质喂养

• 批准号: 9182219
• 负责人: PETER A BURKE
• 金额: $ 26.1万
• 依托单位: BOSTON MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-08-09 至 2018-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9182219
• 关键词: APACHE II; Accident and Emergency department; Acute-Phase Proteins; Admission activity; Amino Acids; Anti-Inflammatory Agents; Anti-inflammatory; Antioxidants; Blinded; Blood; Body Weight; Boston; Branched-Chain Amino Acids; Cessation of life; Collection; Complex; Creatinine; Critical Care; Critical Illness; Development; Dietary Intervention; Down-Regulation; Energy Intake; Enteral Feeding; Enteral Nutrition; Event; Fatty Acids; Fluid overload; Functional disorder; Glutathione; Glycerol; Goals; Head; Histidine; Hormones; Hospitalization; Hour; Hydrocortisone; Hyperglycemia; IL8 gene; Immunologics; Incidence; Infection; Inflammation Mediators; Inflammatory; Inflammatory Response; Infusion procedures; Injury; Intake; Intensive Care Units; Interleukin-6; Intravenous; Lead; Lipid Peroxidation; Lipids; Lung; Malnutrition; Mass Spectrum Analysis; Measurement; Measures; Mediator of activation protein; Medical center; Medicine; Metabolic; Muscular Atrophy; Nuclear Magnetic Resonance; Nutritional Support; Organ; Organ failure; Organism; Outcome; Oxidation-Reduction; Oxidative Stress; Patient-Focused Outcomes; Patients; Peripheral; Phospholipids; Placebos; Plasma; Population; Positioning Attribute; Pre-hospitalization care; Production; Protein Biosynthesis; Proteins; Proteolysis; Publishing; Randomized; Reactive Oxygen Species; Regimen; Reporting; Research Personnel; Role; Stress; Support Groups; Surgical Intensive Care; TNF gene; Techniques; Technology; Time; Training; Trauma; Trauma patient; Traumatic injury; Urea Nitrogen; Urine; Work; acute stress; biological adaptation to stress; clinical investigation; cytokine; feeding; improved; indexing; inflammatory marker; injured; metabolome; metabolomics; mortality; muscle form; nitrogen balance; nutrition; oxidation; prevent; primary outcome; protein intake; response; response to injury; standard of care; wound

Project Summary Establishing early nutrition support post traumatic injury is the standard of care in ICU's. There is ample evidence that early enteral nutrition (within 24-48 hours post injury) is associated with positive outcomes, but controversy persists regarding the optimal amount of nutrition to be fed in the first week post injury. The avoidance of overfeeding to prevent hyperglycemia and fluid overload with a caloric goal of 60-80% of energy requirements may prove optimal as long as there is a supply of protein of at least 1.5 grams/kg /day. Our plan is to randomize in a blinded fashion patients admitted to the Surgical Intensive Care Unit at Boston Medical Center to either receive a peripherally infused amino acid solution to provide at least 1.5 grams pro/kg from within 24 hours of injury or placebo, which is D10W infused at a similar rate for 5 days. These infusions will supplement the normal enteral feedings prescribed and advanced as tolerated for patients in both groups. Measurements will be taken at baseline and again on day 4-5 for plasma markers of inflammation (cytokines) and a metabolomics profile. A 24 hour urine collection will be obtained on day 1 and day 5 in both groups to determine nitrogen balance and Catabolic Index. After five days, infusions will be stopped and patients will continue on their enteral feedings as tolerated. Estimates of daily nutrition intake, incidence of infection and organ dysfunction will be recorded. APACHE II, SIRS and SOFA scores will be measured daily for the first 5 days and then every three days until day 28, discharge or death. The investigators will track the incidence of infections (blood, urine, wound, lung) during their hospitalization using published definitions from Critical Care Medicine. Our primary outcome is to see a difference in the metabolomics profile in the protein infusion group supporting improved protein economy and possibly less fatty acid mobilization. We also anticipate less of an inflammatory response with the amino acid infusion and improved nitrogen balance.

项目摘要 创伤后创伤后建立早期营养支持是ICU的护理标准。那里 有充分的证据表明，早期肠内营养（受伤后24-48小时内）与 积极的结果，但是关于要喂养的最佳营养量仍然存在争议 受伤后的第一周。避免过度喂养以防止高血糖和液体 只要有能量需求的60-80％的热量目标超载，只要 蛋白质的供应至少为1.5克 /kg /天。我们的计划是在盲人中随机进行 时尚患者在波士顿医疗中心接受外科重症监护病房的录取 接收外围注入的氨基酸溶液，以提供至少1.5克Pro/kg 在受伤或安慰剂的24小时内，D10W以相似的速度注入5天。这些 输注将补充规定和先进的正常肠内喂养，以供耐受 两组的患者。测量将在基线和第4-5天再次进行 炎症（细胞因子）和代谢组学的血浆标记。 24小时尿液 两组的收集将在第1天和第5天获得，以确定氮平衡和 分解代谢指数。五天后，将停止输注，患者将继续进行 肠内喂食如耐受性。估计每日营养摄入量，感染发生率和 会记录器官功能障碍。 Apache II，Sirs和Sofa分数将每天测量 在最初的5天，然后每三天直到第28天，出院或死亡。调查人员 将在住院期间跟踪感染的发生率（血液，尿液，伤口，肺） 从重症监护医学发表的定义。我们的主要结果是看到 蛋白质输注组中的代谢组学概况支持蛋白质经济的改善和 可能较少的脂肪酸动员。我们还期望与 氨基酸输注并改善氮平衡。