High calorie intake on ICU has long been known to be a bad idea. Topping up early enteral feeding deficits with parenteral nutrition is now felt to be non-life-saving and possibly dangerous. Animal studies have suggested that it is the protein element of feeding that keeps the mitochondria happy, not calories per se. So, the PermiT study, a refocussed repeat of …
Another addition to this year’s flurry of nutrition work. Tradition has us bypassing the stomach and duodenum for nutrition in pancreatitis – intuitively sensible. To challenge this the Dutch PYTHON trial group has recently published its findings. Multicentredly, they randomized 200-ish patients with acute ‘high-risk’ pancreatitis (defined as mGlasgow of >/= 3, CRP >150, APACHE >/=8) …
Everyone knows early enteral nutrition’s a good thing, don’t they? A large (2400) pragmatic (real-life!), randomised, unblinded trial in non-elective admissions to 33 UK ICUs, CALORIES looked at the difference in early feeding enterally ‘v’ parenterally, powered for a 20% difference (RRR, or 6% ARR) in mortality at 30 days. Feeding was started within 36 …
Heyland, SIGNET, REDOXS, ARDNSNET’s OMEGA, INTERSEPT, and now the Metaplus study. Approximately 300 patients, critically ill (APACHE >15) and ventilated were all given high protein (>1.2g/Kg/day), normal calorie (25Kcal/Kg/day) feed, either with or without Omega-3 acids, glutamine and antioxidants. All were started within 48 hours and stopped within 28 days. No benefit in terms of length of …
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