Trial of the route of early nutritional support in critically ill adults.


Harvey, SE; Parrott, F; Harrison, DA; Bear, DE; Segaran, E; Beale, R; Bellingan, G; Leonard, R; Mythen, MG; Rowan, KM; CALORIES Trial Investigators, ; , COLLABORATORS; Rowan, K; Mythen, M; Baldwin, C; Beale, R; Bellingan, G; Emery, P; Forbes, A; Grieve, R; Grimble, G; Harrison, D; Leonard, R; Montgomery, H; Silk, D; Stroud, M; Emery, P; Forbes, A; Gibb, P; Jones, C; Montgomery, H; Myers, J; Mythen, M; Rowan, K; Williams, D; Allen, E; Andrews, P; Webb, S; Harvey, S; Beale, R; Bear, D; Bellingan, G; Harrison, D; Leonard, R; McLennan, B; Muskett, H; Mythen, M; Parrott, F; Rowan, K; Segaran, E; Tan, J; Anderson, K; Canter, R; Clement, L; Corlett, S; Patel, K; Scott, R; Preller, J; Polgarova, P; Cupritt, J; Baddeley, S; Fletcher, S; Northey, M; Kenny, L; Bewley, J; Pollock, K; Sweet, K; Ball, A; Moreton, S; Szmczakowski, A; McArthur, C; Pallister, K; Watt, P; Raymode, P; Dunk, N; Hopkins, P; Hadfield, D; Wade-Smith, F; Hayden, P; Cooper, L; Pegg, C; Innes, R; Richards, P; Locke, A; Gopal, S; Pooni, JS; Spencer, H; Hutchinson, S; Rosbergen, M; Glister, G; Irving, S; Walker, R; Pinder, A; Webb, S; Bottrill, F; Reschreiter, H; Camsookai, J; Barnes, H; Pogson, D; Rose, S; Lamb, N; Martin, D; Meale, P; James, S; Goldsmith, A; Trodd, D; Martin, J; Hollands, R; Carnahan, M; Creagh-Brown, B; Kirk-Bayley, J; Carvalho, P; Tanser, S; Bolger, C; Golder, K; Higgins, D; Martin, S; Leonard, R; Hauer, V; Ochelli-Okpue, A; Margarson, M; Baird, Y; Dickens, J; Beale, R; Lei, K; Smith, J; Chikungwa, M; Chandan, G; Jackson, C; Lewis, R; Bell, S; Blaylock, H; Dutta, D; Power, J; Keel, C; Moondi, P; Wong, K; Draper, K; Krige, A; Bullock, L; Harrison-Briggs, D; Brealey, D; Ryu, J; Bercades, G; Mostert, M; Harris, C; Grannell, D; Carr, B; Salt, R; Matthews, C; (2014) Trial of the route of early nutritional support in critically ill adults. The New England journal of medicine, 371 (18). pp. 1673-84. ISSN 0028-4793 DOI: 10.1056/NEJMoa1409860

Full text not available from this repository. (Request a copy)

Abstract

Uncertainty exists about the most effective route for delivery of early nutritional support in critically ill adults. We hypothesized that delivery through the parenteral route is superior to that through the enteral route. We conducted a pragmatic, randomized trial involving adults with an unplanned admission to one of 33 English intensive care units. We randomly assigned patients who could be fed through either the parenteral or the enteral route to a delivery route, with nutritional support initiated within 36 hours after admission and continued for up to 5 days. The primary outcome was all-cause mortality at 30 days. We enrolled 2400 patients; 2388 (99.5%) were included in the analysis (1191 in the parenteral group and 1197 in the enteral group). By 30 days, 393 of 1188 patients (33.1%) in the parenteral group and 409 of 1195 patients (34.2%) in the enteral group had died (relative risk in parenteral group, 0.97; 95% confidence interval, 0.86 to 1.08; P=0.57). There were significant reductions in the parenteral group, as compared with the enteral group, in rates of hypoglycemia (44 patients [3.7%] vs. 74 patients [6.2%]; P=0.006) and vomiting (100 patients [8.4%] vs. 194 patients [16.2%]; P<0.001). There were no significant differences between the parenteral group and the enteral group in the mean number of treated infectious complications (0.22 vs. 0.21; P=0.72), 90-day mortality (442 of 1184 patients [37.3%] vs. 464 of 1188 patients [39.1%], P=0.40), in rates of 14 other secondary outcomes, or in rates of adverse events. Caloric intake was similar in the two groups, with the target intake not achieved in most patients. We found no significant difference in 30-day mortality associated with the route of delivery of early nutritional support in critically ill adults. (Funded by the United Kingdom National Institute for Health Research; CALORIES Current Controlled Trials number, ISRCTN17386141.).

Item Type: Article
Faculty and Department: Faculty of Public Health and Policy > Dept of Health Services Research and Policy
Faculty of Epidemiology and Population Health > Dept of Medical Statistics
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Public Health and Policy > Dept of Global Health and Development
PubMed ID: 25271389
Web of Science ID: 343768500005
URI: http://researchonline.lshtm.ac.uk/id/eprint/4336356

Statistics


Download activity - last 12 months
Downloads since deposit
0Downloads
21Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item