Abstract
BackgroundThe properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal tolerance in brain-injured patients, known to suffer gastroparesis. The purpose of this study was to compare the efficacy and tolerance of a semi-elemental versus a polymeric formula for enteral nutrition (EN) in brain-injured critically ill patients.MethodsProspective, randomized study including brain-injured adult patients [Glasgow Coma Scale (GCS) ≤ 8] with an expected duration of mechanical ventilation > 48 h. Intervention: an enteral semi-elemental (SE group) or polymeric (P group) formula. EN was started within 36 h after admission to the intensive care unit and was delivered according to a standardized nurse-driven protocol. The primary endpoint was the percentage of patients who received both 60% of the daily energy goal at 3 days and 100% of the daily energy goal at 5 days after inclusion. Tolerance of EN was assessed by the rate of gastroparesis, vomiting and diarrhea.ResultsRespectively, 100 and 95 patients were analyzed in the SE and P groups: Age (57[44–65] versus 55[40–65] years) and GCS (6[3–7] versus 5[3–7]) did not differ between groups. The percentage of patients achieving the primary endpoint was similar (46% and 48%, respectively; relative risk (RR) [95% confidence interval (CI)] = 1.05 (0.78–1.42); p = 0.73). The mean daily energy intake was, respectively, 20.2 ± 6.3 versus 21.0 ± 6.5 kcal/kg/day (p = 0.42). Protein intakes were 1.3 ± 0.4 versus 1.1 ± 0.3 g/kg/day (p < 0.0001). Respectively, 18% versus 12% patients presented gastroparesis (p = 0.21), and 16% versus 8% patients suffered from diarrhea (p = 0.11). No patient presented vomiting in either group.ConclusionSemi-elemental compared to polymeric formula did not improve daily energy intake or gastrointestinal tolerance of enteral nutrition.Trial registrationEudraCT/ID-RCB 2012-A00078-35 (registered January 17, 2012).
Highlights
The properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal toler‐ ance in brain-injured patients, known to suffer gastroparesis
The mean daily caloric and protein intake were, respectively, 20.2 ± 6.3 versus 21.0 ± 6.5 kcal/kg/day (mean difference (MD) [95% confidence interval (CI)] = − 0.7 (− 2.6 to 1.1); p = 0.42) and 1.3 ± 0.4 versus 1.1 ± 0.3 g/kg/day [95% confidence interval (CI)] = 0.2 (0.1–0.3); p < 0.0001) in the semi-elemental and polymeric groups
Semi-elemental formulae appear to have no beneficial impact on outcome including gastrointestinal tolerance when prescribed in unselected intensive care unit (ICU) patients, and were shown to require a decrease of at least 7% in the number of cases of gastrointestinal intolerance in order to be costeffective in ICU patients [8, 21]
Summary
The properties of semi-elemental enteral nutrition might theoretically improve gastrointestinal toler‐ ance in brain-injured patients, known to suffer gastroparesis. Brain-injured critically ill patients admitted to the intensive care unit (ICU) suffer an increased metabolic rate and protein catabolism, leading to a high risk of energy and protein deficits [1,2,3]. Both are associated with a higher rate of infectious complications, prolonged ICU and hospital length of stay, unfavorable neurological outcome and higher mortality [2, 4]. Gastroparesis and diarrhea might alter nutrient absorption and contribute to inadequate energy and protein intake, and could lead physicians to consider interrupting EN [4]
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