Nutritional support in sepsis: when less may be more

Niekerk, Gustav van; Meaker, Charné; Engelbrecht, Anna‐Mart

doi:10.1186/s13054-020-2771-4

Cited by 26 publications

(31 citation statements)

References 47 publications

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“…In sepsis, more or less nutrition delivery is an updated focus under exploration. Van Niekerk et al [ 32 ] suggested that less nutrition supply may be beneficial during sepsis. However, the PROCASEPT study indicated that low protein intake or caloric restriction may not be of benefit in septic patients[ 33 , 34 ], and overfeeding during days 4-7 was related to a lower 6-mo mortality, compared with low caloric intake[ 34 ].…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon also revealed that enteral underfeeding, especially 60% of goal caloric requirements, may be beneficial to sepsis. The underlying mechanisms of permissive underfeeding were proposed by a recent review[ 32 ]: Suppression of early feeding may result in a synergistic potentiation of catabolism and then promote cell survival and enhance immune function in sepsis. But further clinical and animal studies are required to verify this theory.…”

Section: Discussionmentioning

confidence: 99%

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Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

Sun¹,

Nie²,

Chen³

et al. 2021

WJG

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BACKGROUND Intestinal mucosal barrier injury and gastrointestinal dysfunction are important causes of sepsis. However, few studies have investigated the effects of enteral underfeeding on gastrointestinal function in sepsis. Moreover, no consensus on goal enteral caloric intake has been reached in sepsis. AIM To investigate the effects of different goal caloric requirements of enteral nutrition on the gastrointestinal function and outcomes in the acute phase of sepsis. METHODS Patients were randomly assigned to receive 30% (defined as group A), 60% (group B), or 100% (group C) of goal caloric requirements of enteral nutrition in this prospective pilot clinical trial. The acute gastrointestinal injury (AGI) grades, incidence of feeding intolerance (FI), daily caloric intake, nutritional and inflammatory markers, and biomarkers of mucosal barrier function were collected during the first 7 d of enteral feeding. The clinical severity and outcome variables were also recorded. RESULTS A total of 54 septic patients were enrolled. The days to goal calorie of group C (2.55 ± 0.82) were significantly longer than those of group A (3.50 ± 1.51; P = 0.046) or B (4.85 ± 1.68; P < 0.001). The FI incidence of group C (16.5%) was higher than that of group A (5.0%) or B (8.7%) ( P = 0.009). No difference in the incidence of FI symptoms was found between groups A and B. The serum levels of barrier function biomarkers of group B were significantly lower than those of group A ( P < 0.05) on the 7th day of feeding. The prealbumin and IL-6 levels of group A were lower than those of group B ( P < 0.05) on the 7 th day of feeding. No significant differences in the clinical outcome variables or 28-d mortality were found among the three groups. CONCLUSION Early moderate enteral underfeeding (60% of goal requirements) could improve the intestinal barrier function and nutritional and inflammatory status without increasing the incidence of FI symptoms in sepsis. However, further large-scale prospective clinical trials and animal studies are required to test our findings. Moreover, the effects of different protein intake on gastrointestinal function and outcomes should also be investigated in future work.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effects of permissive hypocaloric vs standard enteral feeding on gastrointestinal function and outcomes in sepsis

Sun¹,

Nie²,

Chen³

et al. 2021

WJG

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“…Lower-level or trophic feeding has been shown to promote intestinal integrity, improve immune function, and prevent bacterial translocation with a lower risk of gastrointestinal side effects [ 16 , 17 , 18 ]. Recent studies have also suggested that overfeeding during critical illness may counter the beneficial effects of catabolism on enhancing autophagic processes that limit tissue injury and improve host resilience, thus favoring a trophic approach [ 19 ]. Current critical care guidelines recommend early trophic enteral nutrition over parenteral nutrition for most patients [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

Physiologic Effects of Exogenous Dextrose in Murine Klebsiella pneumoniae Sepsis Vary by Route of Provision

et al. 2020

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Sepsis is characterized by a dysregulated immune response to infection. Nutrition is important in the care of septic patients, but the effects of specific nutrients on inflammation in sepsis are not well defined. Our prior work has shown benefits from early enteral dextrose infusion in a preclinical endotoxemia model of sepsis. In the current study, we extend our initial work to examine the effects of dextrose infusions, varying by route of administration, on inflammation and glycemic control in a more clinically relevant and translational model of Klebsiella pneumoniae (KP) bacteremia. Ten-week old C57BL6/J male mice (n = 31) underwent the implantation of indwelling vascular catheters, followed by inoculation with oropharyngeal KP. The mice were randomized 24 h after inoculation to (1) intravenous (IV) dextrose, (2) enteral dextrose, or (3) enteral saline (control) to study the effects on systemic inflammation, hemodynamics, and glycemic control. At 72 h, 77% of the control mice died, whereas IV dextrose induced 100% mortality, associated with increased inflammation, hyperglycemia, and hypotension. Enteral dextrose reduced mortality to 27%, promoted euglycemia, and reduced inflammation compared to IV dextrose. We conclude, in a bacteremic model of sepsis, that enteral (but not IV) dextrose administration is protective, suggesting that the route of nutrient support influences inflammation in sepsis.

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“…In a recent review, Van Niekerk and coworkers state permissive underfeeding in septic patients might be beneficial and suggest to investigate the benefits of delayed nutrition in sepsis [1]. They hypothesize that inflammation in sepsis antagonizes the gastrointestinal function in order to sustain catabolism.…”

Section: Dear Editormentioning

confidence: 99%