Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial

Piton, Gaël; Gouge, Amélie Le; Brulé, Noëlle; Cypriani, Benoit; Lachérade, Jean-Claude; Nseir, Saad; Mira, Jean‐Paul; Mercier, Emmanuelle; Sirodot, Michel; Rigaud, Jean‐Philippe; Malaquin, Stéphanie; Soum, Edouard; Djibré, Michel; Gaudry, Stéphane; Thévenin, Didier; Reignier, Jean

doi:10.1007/s00134-019-05649-3

Cited by 45 publications

(26 citation statements)

References 35 publications

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“…Mortality did not differ between the two groups, but a significantly higher rate of bowel ischemia was reported in the enteral group [19 (2%) patients vs 5 (< 1%) patients]. However, an ancillary study focused on citrulline and intestinal-fatty acid binding protein (I-FABP) biomarkers showed possible protective effects of enteral nutrition on enterocyte mass, raising an interest for further investigation[ 41 ]. In particular, some hypothesized that a lower dose of enteral nutrition in these patients may yield a protective effect[ 42 ].…”

Section: Epidemiology Mechanisms and Management Of Nomimentioning

confidence: 99%

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Bourcier¹,

Klug²,

Nguyen³

2021

WJG

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Acute mesenteric ischemia (AMI) is a severe condition associated with poor prognosis, ultimately leading to death due to multiorgan failure. Several mechanisms may lead to AMI, and non-occlusive mesenteric ischemia (NOMI) represents a particular form of AMI. NOMI is prevalent in intensive care units in critically ill patients. In NOMI management, promptness and accuracy of diagnosis are paramount to achieve decisive treatment, but the last decades have been marked by failure to improve NOMI prognosis, due to lack of tools to detect this condition. While real-life diagnostic management relies on a combination of physical examination, several biomarkers, imaging, and endoscopy to detect the possibility of several grades of NOMI, research studies only focus on a few elements at a time. In the era of artificial intelligence (AI), which can aggregate thousands of variables in complex longitudinal models, the prospect of achieving accurate diagnosis through machine-learning-based algorithms may be sought. In the following work, we bring you a state-of-the-art literature review regarding NOMI, its presentation, its mechanics, and the pitfalls of routine work-up diagnostic exams including biomarkers, imaging, and endoscopy, we raise the perspectives of new biomarker exams, and finally we discuss what AI may add to the field, after summarizing what this technique encompasses.

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Section: Epidemiology Mechanisms and Management Of Nomimentioning

confidence: 99%

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Bourcier¹,

Klug²,

Nguyen³

2021

WJG

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“…We speculate early EN in septic shock maintained epithelial and tight junction barrier functions, which may limit gut‐derived inflammation. An ancillary study of the NUTRIREA‐2 trial reported plasma citrulline levels were higher at day 3 in critically ill patients with shock randomized to early EN, as compared with early parenteral nutrition, suggesting early EN is associated with restoration of enterocyte mass and function 21 . Second, early EN initiation without adverse gastrointestinal consequences may have been due to a lesser degree of hemodynamic instability, which is reflected by the magnitude of NE dose.…”

Section: Discussionmentioning

confidence: 99%

Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study

et al. 2020

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Background: Introducing enteral nutrition (EN) during hemodynamic instability may induce the splanchnic steal phenomenon, which may worsen systemic oxygen delivery and increase vasopressor dose. We aimed to determine the change in vasopressor dose in septic shock patients who received concomitant EN. We hypothesize that EN delivery is not associated with worsening hemodynamic instability, as defined by an increase in vasopressor dose ≥50% at 24 hours. Methods: This is a retrospective observational cohort study of adult patients with septic shock who were admitted to the intensive care unit from January 2015 to June 2015 and received EN. Vasopressor and EN parameters were collected at 6-hour intervals for the first 24 hours. Results: Data were available for 28 consecutive patients. The mean age was 60 years (SD = 18), and 54% were females. Norepinephrine (NE) was used in 100%. EN and vasopressor overlap totaled 36 hours (interquartile range [IQR], 27-69). Median NE dose when starting EN was 5.9 μg/min (IQR, 3.88). Median change in dose from 0 to 6 hours was 0.85 μg/min (95% CI, 0.681.06; P = 0.136), corresponding to a median increase of 14.5%. Total NE duration was 60.5 hours (IQR, 47.5-75.5). No serious complications occurred. Conclusion: The median vasopressor dose did not increase by ≥50% during the first 24 hours of EN. This suggests early EN delivered during septic shock is not associated with worsening hemodynamic instability. Limitations include a small sample size and residual confounding. Prospective data are needed.

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“…Esta estrategia requiere de un estrecho monitoreo clínico, pesquisando la aparición de signos de alarma de isquemia intestinal (dolor y distensión abdominal, hipertensión abdominal, hipotensión arterial con aumento del requerimiento del sostén vasopresor) y lactatemia en ascenso, son indicadores posibles de isquemia intestinal. La NE debe ser discontinuada frente al deterioro de la condición hemodinámica, reevaluando la perfusión del tracto intestinal (14) .…”

Section: Terapia Nutricional En Pacientes Con Covid-19 E Inestabilidaunclassified

“…Sin embargo, es posible afirmar que la indicación de NE se asocia a algunas complicaciones cuando el paciente requiere VNI, sobre todo en aquellos en los que esta modalidad ventilatoria se prolonga. En tal sentido, Kogo y colaboradores observaron que más del 50% de los pacientes fueron incapaces de mantener la vía oral y en ellos la tasa de complicaciones fue mayor (53% [32/60] frente a 32% [15/47], p = 0,03), así como los tiempos de ventilación mecánica (16 versus 8 [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] días, p = 0,02) en favor de aquellos pacientes que recibieron NE (18) . La NE minimiza la aparición de complicaciones infecciosas en comparación con la NE tardía y la NP temprana (19) .…”

Section: Pacientes Sin Ventilación Mecánica Invasivaunclassified

Terapia nutricional en el paciente crítico con COVID-19

2020

RMU

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Introducción: el distrés respiratorio agudo y la falla multiorgánica que determinan admisión en una unidad de cuidados intensivos (UCI) son una causa importante de morbimortalidad en pacientes con COVID-19. Los pacientes con peores resultados clínicos-incluido una menor sobrevida en UCI-son aquellos con múltiples comorbilidades, grados variables de inmunocompromiso, adultos mayores e individuos con desnutrición previa o secundaria a la enfermedad crítica. El impacto nutricional de la enfermedad crítica sobre el músculo estriado esquelético puede exacerbarse en algunos pacientes críticamente enfermos, los infectados por SARS-CoV-2 que requieren admisión a UCI. Objetivo: proporcionar una orientación práctica de utilidad para los clínicos basados en la evidencia clínica actualizada y considerando ciertas características claves distintivas de la infección grave por SARS-CoV-2. Método: se realizó una revisión exhaustiva de la literatura científica publicada hasta abril de 2020 en idiomas español e inglés. Conclusiones: la pandemia de COVID-19 determina un desafío sin precedentes en la UCI, dado que no existen al momento medidas preventivas demostradas para evitar la evolución a la enfermedad crítica y los tratamientos curativos disponibles en esta fase de la enfermedad carecen de evidencia clínica de calidad que los sustenten. En este escenario complejo es probable que las medidas que contribuyan a potenciar el sistema inmunitario y las terapias de sostén en la UCI (incluido el soporte nutricional) sean armas sustanciales contra las infecciones graves por SARS-CoV-2; sin embargo, son necesarios más estudios en el entorno de la UCI para realizar recomendaciones específicas. Palabras clave: Cuidados críticos Coronavirus Unidades de cuidados intensivos Apoyo nutricional COVID-19 Infecciones por coronavirus

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Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial

Cited by 45 publications

References 35 publications

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Non-occlusive mesenteric ischemia: Diagnostic challenges and perspectives in the era of artificial intelligence

Impact of Enteral Feeding on Vasoactive Support in Septic Shock: A Retrospective Observational Study

Terapia nutricional en el paciente crítico con COVID-19

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