Impact of nutrition route on microaspiration in critically ill patients with shock: a planned ancillary study of the NUTRIREA-2 trial.
| Title: | Impact of nutrition route on microaspiration in critically ill patients with shock: a planned ancillary study of the NUTRIREA-2 trial. |
|---|---|
| Authors: | Nseir S; Médecine Intensive Réanimation, CHU Lille, F-59000, Lille, France. s-nseir@chru-lille.fr.; Faculté de Médicine, Université de Lille, F-59000, Lille, France. s-nseir@chru-lille.fr.; Le Gouge A; Inserm CIC 1415, Tours, France.; Université de Tours, Tours, France.; CHU Tours, Tours, France.; Lascarrou JB; Médecine Intensive Réanimation, CHU de Nantes, Nantes, France.; Université de Nantes, Nantes, France.; Lacherade JC; Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche-sur-Yon, France.; Jaillette E; Médecine Intensive Réanimation, CHU Lille, F-59000, Lille, France.; Faculté de Médicine, Université de Lille, F-59000, Lille, France.; Mira JP; Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.; Mercier E; Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France.; Declercq PL; Médecine Intensive Réanimation, Hôpital de Dieppe, Dieppe, France.; Sirodot M; Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France.; Piton G; Medical Intensive Care Unit, CHRU Besançon, Besançon, France.; EA3920, Université de Franche Comté, Besançon, France.; Tinturier F; Surgical Intensive Care Unit, CHU Amiens Picardie, Amiens, France.; Coupez E; Intensive Care Unit, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France.; Gaudry S; Service de Réanimation Médico-Chirurgicale, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris (AP-HP), Bobigny, France.; INSERM, UMR_S1155, Remodeling and Repair of Renal Tissue, Hôpital Tenon, Paris, Paris, France.; Djibré M; Medical-Surgical Intensive Care Unit, Tenon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.; Thevenin D; Medical-Surgical Intensive Care Unit, Centre Hospitalier Docteur Schaffner, Lens, France.; Pasco J; Inserm CIC 1415, Tours, France.; Université de Tours, Tours, France.; CHU Tours, Tours, France.; Balduyck M; Centre de Biologie Pathologie, CHU Lille, F-59000, Lille, France.; Faculté de Pharmacie, Université de Lille, F-59000, Lille, France.; Zerimech F; Centre de Biologie Pathologie, CHU Lille, F-59000, Lille, France.; Reignier J; Médecine Intensive Réanimation, CHU de Nantes, Nantes, France.; Université de Nantes, Nantes, France. |
| Source: | Critical care (London, England) [Crit Care] 2019 Apr 05; Vol. 23 (1), pp. 111. Date of Electronic Publication: 2019 Apr 05. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Ltd Country of Publication: England NLM ID: 9801902 Publication Model: Electronic Cited Medium: Internet ISSN: 1466-609X (Electronic) Linking ISSN: 13648535 NLM ISO Abbreviation: Crit Care Subsets: MEDLINE |
| Imprint Name(s): | Publication: London, UK : BioMed Central Ltd; Original Publication: London : Current Science Ltd, c1997- |
| MeSH Terms: | Drug Administration Routes*; Nutrition Therapy/*standards ; Shock/*diet therapy; Critical Illness/therapy ; Inhalation/physiology ; Intensive Care Units/organization & administration ; Intensive Care Units/statistics & numerical data ; Nutrition Therapy/instrumentation ; Nutrition Therapy/methods ; Aged ; Bodily Secretions ; Female ; Gastric Juice ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Time Factors |
| Abstract: | Background: Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions.; Methods: Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial. Patients with shock receiving invasive mechanical ventilation were randomized to receive early enteral or parenteral nutrition. All tracheal aspirates were collected during the 48 h following randomization. Abundant microaspiration of gastric contents and oropharyngeal secretions was defined as the presence of significant levels of pepsin (> 200 ng/ml) and salivary amylase (> 1685 UI/ml) in > 30% of tracheal aspirates.; Results: A total of 151 patients were included (78 and 73 patients in enteral and parenteral nutrition groups, respectively), and 1074 tracheal aspirates were quantitatively analyzed for pepsin and amylase. Although vomiting rate was significantly higher (31% vs 15%, p = 0.016), constipation rate was significantly lower (6% vs 21%, p = 0.010) in patients with enteral than in patients with parenteral nutrition. No significant difference was found regarding other patient characteristics. The percentage of patients with abundant microaspiration of gastric contents was significantly lower in enteral than in parenteral nutrition groups (14% vs 36%, p = 0.004; unadjusted OR 0.80 (95% CI 0.69, 0.93), adjusted OR 0.79 (0.76, 0.94)). The percentage of patients with abundant microaspiration of oropharyngeal secretions was significantly higher in enteral than in parenteral nutrition groups (74% vs 54%, p = 0.026; unadjusted OR 1.21 (95% CI 1.03, 1.44), adjusted OR 1.23 (1.01, 1.48)). No significant difference was found in percentage of patients with ventilator-associated pneumonia between enteral (8%) and parenteral (10%) nutrition groups (HR 0.78 (0.26, 2.28)).; Conclusions: Our results suggest that enteral and parenteral nutrition are associated with high rates of microaspiration, although oropharyngeal microaspiration was more common with enteral nutrition and gastric microaspiration was more common with parenteral nutrition.; Trial Registration: ClinicalTrials.gov, NCT03411447 . Registered 18 July 2017. Retrospectively registered. |
| References: | Lancet. 1999 Nov 27;354(9193):1851-8. (PMID: 10584721); Oral Dis. 2002 May;8(3):117-29. (PMID: 12108756); Crit Care Med. 2006 Apr;34(4):1007-15. (PMID: 16484901); Gastroenterol Clin North Am. 1991 Sep;20(3):511-29. (PMID: 1717380); Infect Disord Drug Targets. 2011 Aug;11(4):413-23. (PMID: 21679139); Am J Respir Crit Care Med. 2011 Nov 1;184(9):1041-7. (PMID: 21836137); JAMA. 2013 Jan 16;309(3):249-56. (PMID: 23321763); Lancet Infect Dis. 2013 Aug;13(8):665-71. (PMID: 23622939); Ann Intensive Care. 2014 Feb 27;4(1):7. (PMID: 24572178); PLoS One. 2014 Mar 06;9(6):e90851. (PMID: 24603906); Monogr Oral Sci. 2014;24:14-29. (PMID: 24862591); Psychoneuroendocrinology. 2014 Nov;49:290-8. (PMID: 25128931); BMC Infect Dis. 2014 Nov 28;14:119. (PMID: 25430629); Trials. 2014 Dec 23;15:507. (PMID: 25539571); Am J Respir Crit Care Med. 2015 Mar 15;191(6):637-45. (PMID: 25584431); Intensive Care Med. 2015 May;41(5):875-86. (PMID: 25792207); Trials. 2015 Sep 25;16:429. (PMID: 26407612); Ann Intensive Care. 2016 Dec;6(1):93. (PMID: 27704488); Intensive Care Med. 2017 Mar;43(3):380-398. (PMID: 28168570); Lancet. 2018 Jan 13;391(10116):133-143. (PMID: 29128300); Ann Intern Med. 1994 Apr 15;120(8):653-62. (PMID: 8135449); Am J Respir Crit Care Med. 1995 Dec;152(6 Pt 1):1825-34. (PMID: 8520743); Am J Respir Crit Care Med. 1997 Nov;156(5):1647-55. (PMID: 9372689) |
| Grant Information: | PHRC-12-0184 French Ministry of Health |
| Contributed Indexing: | Keywords: Critical care; Gastric contents; Microaspiration; Oropharyngeal secretions; Pathophysiology; Pneumonia |
| Molecular Sequence: | ClinicalTrials.gov NCT03411447 |
| Entry Date(s): | Date Created: 20190407 Date Completed: 20191212 Latest Revision: 20200225 |
| Update Code: | 20260130 |
| PubMed Central ID: | PMC6451282 |
| DOI: | 10.1186/s13054-019-2403-z |
| PMID: | 30953553 |
| Database: | MEDLINE |
Journal Article