Trial of the route of early nutritional support in critically ill adults
Sheila E Harvey, Francesca Parrott, David A Harrison, Danielle E Bear, Ella Segaran, Richard Beale, Geoff Bellingan, Richard Leonard, Michael G Mythen, Kathryn M Rowan, CALORIES Trial Investigators, Kathryn Rowan, Michael Mythen, Christine Baldwin, Richard Beale, Geoff Bellingan, Peter Emery, Alastair Forbes, Richard Grieve, George Grimble, David Harrison, Richard Leonard, Hugh Montgomery, David Silk, Michael Stroud, Peter Emery, Alastair Forbes, Peter Gibb, Carys Jones, Hugh Montgomery, Janet Myers, Michael Mythen, Kathryn Rowan, Dewi Williams, Elizabeth Allen, Peter Andrews, Steve Webb, Sheila Harvey, Richard Beale, Danielle Bear, Geoff Bellingan, David Harrison, Richard Leonard, Blair McLennan, Hannah Muskett, Michael Mythen, Francesca Parrott, Kathryn Rowan, Ella Segaran, Jermaine Tan, Kimberley Anderson, Ruth Canter, Louise Clement, Sarah Corlett, Krishna Patel, Rachael Scott, Jacobus Preller, Petra Polgarova, Jason Cupritt, Sally Baddeley, Stephen Fletcher, Martin Northey, Linda Kenny, Jeremy Bewley, Kathryn Pollock, Katie Sweet, Andy Ball, Sarah Moreton, Andrzei Szmczakowski, Carol McArthur, Kimberley Pallister, Philip Watt, Parizade Raymode, Nigel Dunk, Philip Hopkins, Daniel Hadfield, Fiona Wade-Smith, Paul Hayden, Lucy Cooper, Claire Pegg, Richard Innes, Pippa Richards, Angela Locke, Shameer Gopal, Jagtar Singh Pooni, Hazel Spencer, Steve Hutchinson, Melissa Rosbergen, Georgina Glister, Sarah Irving, Rachel Walker, Angela Pinder, Stephen Webb, Fiona Bottrill, Henrik Reschreiter, Julie Camsookai, Helena Barnes, David Pogson, Steve Rose, Nicola Lamb, Daniel Martin, Paula Meale, Sarah James, Arthur Goldsmith, Dawn Trodd, Jane Martin, Robin Hollands, Mandy Carnahan, Ben Creagh-Brown, Justin Kirk-Bayley, Peter Carvalho, Susan Tanser, Clare Bolger, Kim Golder, David Higgins, Sarah Martin, Richard Leonard, Verena Hauer, Adaeze Ochelli-Okpue, Mike Margarson, Yolanda Baird, Justin Dickens, Richard Beale, Katie Lei, John Smith, Moses Chikungwa, Garud Chandan, Claire Jackson, Robert Lewis, Stephanie Bell, Heather Blaylock, Dev Dutta, Jackie Power, Carol Keel, Parvez Moondi, Kate Wong, Katharine Draper, Anton Krige, Lynne Bullock, Donna Harrison-Briggs, David Brealey, Jung Ryu, Georgia Bercades, Marthin Mostert, Clair Harris, David Grannell, Bryan Carr, Ruth Salt, Claire Matthews, Sheila E Harvey, Francesca Parrott, David A Harrison, Danielle E Bear, Ella Segaran, Richard Beale, Geoff Bellingan, Richard Leonard, Michael G Mythen, Kathryn M Rowan, CALORIES Trial Investigators, Kathryn Rowan, Michael Mythen, Christine Baldwin, Richard Beale, Geoff Bellingan, Peter Emery, Alastair Forbes, Richard Grieve, George Grimble, David Harrison, Richard Leonard, Hugh Montgomery, David Silk, Michael Stroud, Peter Emery, Alastair Forbes, Peter Gibb, Carys Jones, Hugh Montgomery, Janet Myers, Michael Mythen, Kathryn Rowan, Dewi Williams, Elizabeth Allen, Peter Andrews, Steve Webb, Sheila Harvey, Richard Beale, Danielle Bear, Geoff Bellingan, David Harrison, Richard Leonard, Blair McLennan, Hannah Muskett, Michael Mythen, Francesca Parrott, Kathryn Rowan, Ella Segaran, Jermaine Tan, Kimberley Anderson, Ruth Canter, Louise Clement, Sarah Corlett, Krishna Patel, Rachael Scott, Jacobus Preller, Petra Polgarova, Jason Cupritt, Sally Baddeley, Stephen Fletcher, Martin Northey, Linda Kenny, Jeremy Bewley, Kathryn Pollock, Katie Sweet, Andy Ball, Sarah Moreton, Andrzei Szmczakowski, Carol McArthur, Kimberley Pallister, Philip Watt, Parizade Raymode, Nigel Dunk, Philip Hopkins, Daniel Hadfield, Fiona Wade-Smith, Paul Hayden, Lucy Cooper, Claire Pegg, Richard Innes, Pippa Richards, Angela Locke, Shameer Gopal, Jagtar Singh Pooni, Hazel Spencer, Steve Hutchinson, Melissa Rosbergen, Georgina Glister, Sarah Irving, Rachel Walker, Angela Pinder, Stephen Webb, Fiona Bottrill, Henrik Reschreiter, Julie Camsookai, Helena Barnes, David Pogson, Steve Rose, Nicola Lamb, Daniel Martin, Paula Meale, Sarah James, Arthur Goldsmith, Dawn Trodd, Jane Martin, Robin Hollands, Mandy Carnahan, Ben Creagh-Brown, Justin Kirk-Bayley, Peter Carvalho, Susan Tanser, Clare Bolger, Kim Golder, David Higgins, Sarah Martin, Richard Leonard, Verena Hauer, Adaeze Ochelli-Okpue, Mike Margarson, Yolanda Baird, Justin Dickens, Richard Beale, Katie Lei, John Smith, Moses Chikungwa, Garud Chandan, Claire Jackson, Robert Lewis, Stephanie Bell, Heather Blaylock, Dev Dutta, Jackie Power, Carol Keel, Parvez Moondi, Kate Wong, Katharine Draper, Anton Krige, Lynne Bullock, Donna Harrison-Briggs, David Brealey, Jung Ryu, Georgia Bercades, Marthin Mostert, Clair Harris, David Grannell, Bryan Carr, Ruth Salt, Claire Matthews
Abstract
Background: Uncertainty exists about the most effective route for delivery of early nutritional support in critically ill adults. We hypothesized that delivery through the parenteral route is superior to that through the enteral route.
Methods: We conducted a pragmatic, randomized trial involving adults with an unplanned admission to one of 33 English intensive care units. We randomly assigned patients who could be fed through either the parenteral or the enteral route to a delivery route, with nutritional support initiated within 36 hours after admission and continued for up to 5 days. The primary outcome was all-cause mortality at 30 days.
Results: We enrolled 2400 patients; 2388 (99.5%) were included in the analysis (1191 in the parenteral group and 1197 in the enteral group). By 30 days, 393 of 1188 patients (33.1%) in the parenteral group and 409 of 1195 patients (34.2%) in the enteral group had died (relative risk in parenteral group, 0.97; 95% confidence interval, 0.86 to 1.08; P=0.57). There were significant reductions in the parenteral group, as compared with the enteral group, in rates of hypoglycemia (44 patients [3.7%] vs. 74 patients [6.2%]; P=0.006) and vomiting (100 patients [8.4%] vs. 194 patients [16.2%]; P<0.001). There were no significant differences between the parenteral group and the enteral group in the mean number of treated infectious complications (0.22 vs. 0.21; P=0.72), 90-day mortality (442 of 1184 patients [37.3%] vs. 464 of 1188 patients [39.1%], P=0.40), in rates of 14 other secondary outcomes, or in rates of adverse events. Caloric intake was similar in the two groups, with the target intake not achieved in most patients.
Conclusions: We found no significant difference in 30-day mortality associated with the route of delivery of early nutritional support in critically ill adults. (Funded by the United Kingdom National Institute for Health Research; CALORIES Current Controlled Trials number, ISRCTN17386141.).
Source: PubMed