Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2)

Reignier, Jean; Boisramé-Helms, Julie; Brisard, Laurent; Lascarrou, Jean-Baptiste; Hssain, Ali Ait; Anguel, Nadia; Argaud, Laurent; Asehnoune, Karim; Asfar, Pierre; Bellec, Frédéric; Botoc, Vlad; Bretagnol, Anne; Bui, Hoang-Nam; Canet, Emmanuel; Silva, Daniel da; Darmon, Michaël; Das, Vincent; Devaquet, Jérôme; Djibré, Michel; Ganster, Frédérique; Garrouste-Orgeas, Maïté; Gaudry, Stéphane; Gontier, Olivier; Guérin, Claude; Guidet, Bertrand; Guitton, Christophe; Herbrecht, Jean-Étienne; Lachérade, Jean-Claude; Letocart, Philippe; Martino, Frédéric; Maxime, Virginie; Mercier, Emmanuelle; Mira, Jean‐Paul; Nseir, Saad; Piton, Gaël; Quenot, Jean‐Pierre; Richecoeur, Jack; Rigaud, Jean‐Philippe; Robert, R.; Rolin, Nathalie; Schwebel, Carole; Sirodot, Michel; Tinturier, F.; Thévenin, Didier; Giraudeau, Bruno; Gouge, Amélie Le; Dupont, Hervé; Pierrot, Marc; Beloncle, François; Combaux, Danièle; Mercier, Romain; Winiszewski, Hadrien; Capellier, Gilles; Hilbert, Gilles; Gruson, Didier; Kalfon, Pierre; Souweine, Bertrand; Coupez, Elizabeth; Ricard, Jean‐Damien; Messika, Jonathan; Bougerol, François; Declercq, Pierre-Louis; Dargent, Auguste; Large, Audrey; Annane, Djillali; Clair, Bernard; Bonadona, Agnès; Hamidfar, Rébecca; Richard, Christian; Henry-Lagarrigue, M.; Yehia, Ahiem Yehia; Temime, Johanna; Barrailler, Stéphanie; Favory, Raphaël; Parmentier-Decrucq, Erika; Jourdain, M.; Baboi, Loredana; Simon, Marie; Baudry, Thomas; Monchi, Mehran; Roustan, Jérôme; Bardou, Patrick; Cottereau, Alice; Guiot, P.; Brulé, Noëlle; Landais, Mickaël; Roquilly, Antoine; Boulain, Thierry; Benzekri, Dalila; Champigneulle, Benoît; Tahiri, Jalel; Misset, Benoît; Lemiale, Virginie; Zafrani, Lara; Fartoukh, Muriel; Thiéry, Guillaume; Chatellier, Delphine; Coudroy, Rémi; Chouquer, Renaud; Gay, Samuel; Brasse, Christine; Delahaye, Arnaud; Preda, Gabriel; Ferreira, Luis; Vermesch, R.; Chevalier, Stéphanie; Quentin, Charlotte; Maestraggi, Quentin; Schneider, Francis; Meziani, Ferhat; Cerf, Charles; Trebbia, Grégoire; Salmon-Gandonnière, Charlotte; Bodet-Contentin, Laëtitia

doi:10.1016/s0140-6736(17)32146-3

Cited by 431 publications

(419 citation statements)

References 41 publications

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“…Despite nutrition support being available for many years, there is limited conclusive evidence favoring any aspect of its use. Prior studies have failed to demonstrate the efficacy of early parenteral nutrition in critically ill patients, and the most recent studies suggest early feeding, whether enteral or parenteral, may be equivalent [95]. Comparing early full enteral nutrition with limited caloric intake ("trophic feeds") one large study found only small differences in gastrointestinal intolerance without evidence of harm or benefit, whereas a smaller, more recent retrospective study on patients in septic shock suggested that trophic feeds may reduce the duration of mechanical ventilation and length of stay in the ICU [93,96].…”

Section: Determine the Efficacy Of "Blood Purification" Therapies Sucmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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Objective: To identify research priorities in the management, epidemiology, outcome and underlying causes of sepsis and septic shock.Design: A consensus committee of 16 international experts representing the European Society of Intensive Care Medicine and Society of Critical Care Medicine was convened at the annual meetings of both societies. Subgroups had teleconference and electronic-based discussion. The entire committee iteratively developed the entire document and recommendations.Methods: Each committee member independently gave their top five priorities for sepsis research. A total of 88 suggestions (ESM 1 -supplemental table 1) were grouped into categories by the committee co-chairs, leading to the formation of seven subgroups: infection, fluids and vasoactive agents, adjunctive therapy, administration/epidemiology, scoring/identification, post-intensive care unit, and basic/translational science. Each subgroup had teleconferences to go over each priority followed by formal voting within each subgroup. The entire committee also voted on top priorities across all subgroups except for basic/translational science. Results:The Surviving Sepsis Research Committee provides 26 priorities for sepsis and septic shock. Of these, the top six clinical priorities were identified and include the following questions: (1) can targeted/personalized/precision medicine approaches determine which therapies will work for which patients at which times?; (2) what are ideal endpoints for volume resuscitation and how should volume resuscitation be titrated?; (3) should rapid diagnostic tests be implemented in clinical practice?; (4) should empiric antibiotic combination therapy be used in sepsis or septic shock?; (5) what are the predictors of sepsis long-term morbidity and mortality?; and (6) what information identifies organ dysfunction?Conclusions: While the Surviving Sepsis Campaign guidelines give multiple recommendations on the treatment of sepsis, significant knowledge gaps remain, both in bedside issues directly applicable to clinicians, as well as understanding the fundamental mechanisms underlying the development and progression of sepsis. The priorities identified represent a roadmap for research in sepsis and septic shock.

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Section: Determine the Efficacy Of "Blood Purification" Therapies Sucmentioning

confidence: 99%

Surviving sepsis campaign: research priorities for sepsis and septic shock

et al. 2018

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“…On 8 November 2017 the findings of the NUTRIREA-2 trial were published in the Lancet (1). The NUTRIREA-2 trial is a large (n=2,400) randomised controlled trial assessing the effect of the route of nutritional support in critically ill adults without contraindications to enteral nutrition (EN) or parenteral nutrition (PN).…”

Section: Feeding Routementioning

confidence: 99%

Feeding route or learning route for nutrition in critically ill

Weijs

2018

J. Thorac. Dis.

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“…Other RCTs did not demonstrate the superiority of "standard" caloric goals compared to trophic feeding and permissive underfeeding [14,15]. An observational study on mechanically ventilated patients with shock suggested that early nutrition, but not the route and the dose, have an impact on survival [13]. These data are in line with the most recent meta-analysis showing no difference between early EN and PN, but reduced mortality and lower incidence of pneumonia with early compared to delayed EN [16].…”

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confidence: 99%

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confidence: 99%

“…Recent RCTs have shown no differences in survival and nosocomial infections in patients receiving early parenteral nutrition (PN) compared to early EN [12,13]. However, compared to early PN, EEN was associated with more bowel ischemia when studied in patients with shock [13]. Other RCTs did not demonstrate the superiority of "standard" caloric goals compared to trophic feeding and permissive underfeeding [14,15].…”

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confidence: 99%

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