Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial.
| Title: | Factors associated with acute mesenteric ischemia among critically ill ventilated patients with shock: a post hoc analysis of the NUTRIREA2 trial. |
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| Authors: | Piton G; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Besançon, Besançon, France. gpiton@chu-besancon.fr.; Service de Réanimation Médicale, CHRU de Besançon, Boulevard Fleming, 25030, Besançon, France. gpiton@chu-besancon.fr.; Le Gouge A; Inserm CIC 1415, Tours, France.; Centre Hospitalier Universitaire de Tours, Tours, France.; Boisramé-Helms J; EA 7293, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Faculté de Médecine, Université de Strasbourg, Strasbourg, France.; Medical Intensive Care Unit, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, Strasbourg, France.; Anguel N; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bicêtre, Assistance Publique-Hôpitaux de Paris, Paris, France.; Argaud L; Service de Médecine Intensive Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France.; Asfar P; 6 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Angers, Angers, France.; Botoc V; Service de Médecine Intensive Réanimation, Centre Hospitalier de Saint Malo, Saint-Malo, France.; Bretagnol A; Service de Médecine Intensive Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France.; Brisard L; Service d'Anesthésie Réanimation Chirurgicale, Hopital Laënnec, Centre Hospitalier Universitaire de Nantes, Nantes, France.; Bui HN; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France.; Canet E; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.; Université de Nantes, Nantes, France.; Chatelier D; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Poitiers, Poitiers, France.; Chauvelot L; Service de Médecine Intensive Réanimation, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France.; Darmon M; 16 Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Saint Louis, Assistance Publique-Hôpitaux de Paris, Paris, France.; Das V; Service de Médecine Intensive Réanimation, Centre Hospitalier Intercommunal André Grégoire, Montreuil, France.; Devaquet J; Service de Réanimation Polyvalente, Hôpital Foch, Suresnes, France.; Djibré M; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France.; Ganster F; Service de Reanimation, Hopital de Mulhouse, Mulhouse, France.; Garrouste-Orgeas M; Service de Reanimation, Hopital Saint-Joseph, Paris, France.; Gaudry S; Service de Médecine Intensive Réanimation, Hôpital Avicenne, Assistance Publique-Hôpitaux de Paris, Bobigny, France.; Gontier O; 25 Service de Médecine Intensive Réanimation, Centre Hospitalier de Chartres, Chartres, France.; Groyer S; Service de Médecine Intensive Réanimation, Centre Hospitalier de Montauban, Montauban, France.; Guidet B; Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: épidémiologie hospitalière qualité et organisation des soins,, 75012, Paris, France.; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 75012, Paris, France.; Herbrecht JE; Service de Médecine Intensive Réanimation, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France.; Hourmant Y; Centre Hospitalier Universitaire de Nantes, Pôle Anesthésie Réanimations, Service d'Anesthésie Réanimation ChirurgicaleHôtel Dieu, 44093, Nantes, France.; Lacherade JC; Service de Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France.; Letocart P; Service de Médecine Intensive Réanimation, Centre Hospitalier Jacques Puel, Rodez, France.; Martino F; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Pointe-à-Pitre-Abymes, Pointe-à-Pitre, Guadeloupe, France.; Maxime V; Service de Médecine Intensive Réanimation, Hôpital Raymond Poincaré, Assistance Publique des Hôpitaux de Paris, Garches, France.; Inserm U 1173, Université de Versailles-Saint Quentin en Yvelines, Versailles, France.; Mercier E; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Bretonneau, CRICS-TRIGGERSEP Network, Tours, France.; Mira JP; Service de Médecine Intensive Réanimation, Hôpital Cochin, Groupe Hospitalier Centre-Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France.; Nseir S; CHU de Lille, Médecine Intensive Réanimation, Lille, France.; Université de Lille, Inserm U1285, CNRS, UMR 8576-UGSF, Unité de Glycobiologie Structurale et Fonctionnelle, 59000, Lille, France.; Quenot JP; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire François Mitterrand, Dijon, France.; Lipness Team, INSERM, LabExLipSTICUniversité de Bourgogne, Dijon, France.; INSERM Centres d'Investigation Clinique, Département d'épidémiologie clinique, Université de Bourgogne, Dijon, France.; Richecoeur J; Service de Médecine Intensive Réanimation, Centre Hospitalier de Beauvais, Beauvais, France.; Rigaud JP; Service de Médecine Intensive Réanimation, Centre Hospitalier de Dieppe, Dieppe, France.; Roux D; Service de Médecine Intensive Réanimation, Hôpital Louis-Mourier, Assistance Publique-Hôpitaux de Paris, Colombes, France.; Schnell D; Service de Médecine Intensive Réanimation, Centre Hospitalier d'Angoulême, Angoulême, France.; Schwebel C; Service de Médecine Intensive Réanimation, Université de Grenoble-Alpes, Grenoble, France.; INSERM 1039, Grenoble, France.; Silva D; Service de Médecine Intensive Réanimation, Hôpital Delafontaine, Saint-Denis, France.; Sirodot M; Service de Médecine Intensive Réanimation, Centre Hospitalier Annecy Genevois, Pringy, France.; Souweine B; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire Gabriel-Montpied, Clermont-Ferrand, France.; Thieulot-Rolin N; Service de Médecine Intensive Réanimation, Centre Hospitalier Marc Jacquet, Melun, France.; Tinturier F; Service de Réanimation Chirurgicale, Centre Hospitalier Universitaire Amiens-Picardie, Amiens, France.; Tirot P; Service de Médecine Intensive Réanimation, Centre Hospitalier du Mans, Le Mans, France.; Thévenin D; Service de Médecine Intensive Réanimation, Centre Hospitalier de Lens, Lens, France.; Thiéry G; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Saint Etienne, Saint Priest en Jarez, France.; Lascarrou JB; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.; Université de Nantes, Nantes, France.; Reignier J; Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire de Nantes, Nantes, France.; Université de Nantes, Nantes, France. |
| Corporate Authors: | Clinical Research in Intensive Care and Sepsis (CRICS) group |
| Source: | Intensive care medicine [Intensive Care Med] 2022 Apr; Vol. 48 (4), pp. 458-466. Date of Electronic Publication: 2022 Feb 22. |
| Publication Type: | Journal Article; Randomized Controlled Trial |
| Language: | English |
| Journal Info: | Publisher: Springer Verlag Country of Publication: United States NLM ID: 7704851 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-1238 (Electronic) Linking ISSN: 03424642 NLM ISO Abbreviation: Intensive Care Med Subsets: MEDLINE |
| Imprint Name(s): | Publication: New York : Springer Verlag; Original Publication: Berlin ; New York, Springer International. |
| MeSH Terms: | Critical Illness*/therapy ; Mesenteric Ischemia*/etiology ; Mesenteric Ischemia*/therapy; Parenteral Nutrition/methods ; Respiration, Artificial/adverse effects ; Adult ; Aged ; Female ; Humans ; Intensive Care Units ; Male ; Retrospective Studies |
| Abstract: | Purpose: Acute mesenteric ischemia (AMI) is a rare, but life-threatening condition occurring among critically ill patients. Several factors have been associated with AMI, but the causal link is debated, most studies being retrospective. Among these factors, enteral nutrition (EN) could be associated with AMI, in particular among patients with shock. We aimed to study the factors independently associated with AMI in a post hoc analysis of the NUTRIREA-2 trial including 2410 critically ill ventilated patients with shock, randomly assigned to receive EN or parenteral nutrition (PN).; Methods: Post hoc analysis of the NUTRIREA-2 trial was conducted. Ventilated adults with shock were randomly assigned to receive EN or PN. AMI was assessed by computed tomography, endoscopy, or laparotomy. Factors associated with AMI were studied by univariate and multivariate analysis.; Results: 2410 patients from 44 French intensive care units (ICUs) were included in the study: 1202 patients in the enteral group and 1208 patients in the parenteral group. The median age was 67 [58-76] years, with 67% men, a SAPS II score of 59 [46-74], and a medical cause for ICU admission in 92.7%. AMI was diagnosed among 24 (1%) patients, mainly by computed tomography (79%) or endoscopy (38%). The mechanism of AMI was non-occlusive mesenteric ischemia (n = 12), occlusive (n = 4), and indeterminate (n = 8). The median duration between inclusion in the trial and AMI diagnosis was 4 [1-11] days. Patients with AMI were older, had a higher SAPS II score at ICU admission, had higher plasma lactate, creatinine, and ASAT concentrations and lower hemoglobin concentration, had more frequently EN, dobutamine, and CVVHDF at inclusion, developed more frequently bacteremia during ICU stay, and had higher 28-day and 90-day mortality rates compared with patients without AMI. By multivariate analysis, AMI was independently associated with EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin concentration ≤ 10.9 g/dL.; Conclusion: Among critically ill ventilated patients with shock, EN, dobutamine use, SAPS II score ≥ 62 and hemoglobin ≤ 10.9 g/dL were independently associated with AMI. Among critically ill ventilated patients requiring vasopressors, EN should be delayed or introduced cautiously in case of low cardiac output requiring dobutamine and/or in case of multiple organ failure with high SAPS II score.; (© 2022. Springer-Verlag GmbH Germany, part of Springer Nature.) |
| Comments: | Comment in: Intensive Care Med. 2022 Jun;48(6):781-782. doi: 10.1007/s00134-022-06689-y.. (PMID: 35348818); Comment in: Intensive Care Med. 2022 Aug;48(8):1122-1124. doi: 10.1007/s00134-022-06741-x.. (PMID: 35618924) |
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| Grant Information: | PHRCN-12-0184. Ministère de l'Enseignement Supérieur et de la Recherche |
| Contributed Indexing: | Keywords: Acute mesenteric ischemia; Critically ill; Enteral nutrition; Parenteral nutrition; Shock |
| Entry Date(s): | Date Created: 20220222 Date Completed: 20220330 Latest Revision: 20220802 |
| Update Code: | 20260130 |
| DOI: | 10.1007/s00134-022-06637-w |
| PMID: | 35190840 |
| Database: | MEDLINE |
Journal Article; Randomized Controlled Trial