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29.05.2019 | Original

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

verfasst von: Gaël Piton, Amélie Le Gouge, Noelle Brulé, Benoit Cypriani, Jean-Claude Lacherade, Saad Nseir, Jean-Paul Mira, Emmanuelle Mercier, Michel Sirodot, Jean-Philippe Rigaud, Stéphanie Malaquin, Edouard Soum, Michel Djibre, Stéphane Gaudry, Didier Thévenin, Jean Reignier

Erschienen in: Intensive Care Medicine | Ausgabe 7/2019

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Abstract

Purpose

The effects of the route of nutrition on the gut mucosa of patients with shock are unclear. Plasma citrulline concentration is a marker of enterocyte mass, and plasma intestinal fatty acid binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to study the effect of the route of nutrition on plasma citrulline concentration measured at day 3 of nutrition.

Materials and methods

Ancillary study of the NUTRIREA-2 trial. Ventilated adults with shock were randomly assigned to receive enteral or parenteral nutrition. Enterocyte biomarkers were measured at baseline, day 3, and day 8 of nutrition.

Result

A total of 165 patients from 13 French ICUs were included in the study: 85 patients in the enteral group and 80 patients in the parenteral group. At baseline, plasma citrulline was low without difference between groups (12.2 µmol L⁻¹ vs 13.3 µmol L⁻¹). At day 3, plasma citrulline concentration was higher in the enteral group than in the parenteral group (18.7 µmol L⁻¹ vs 15.3 µmol L⁻¹, p = 0.01). Plasma I-FABP concentration was increased at baseline, without difference between groups (245 pg mL⁻¹ vs 244 pg mL⁻¹). Plasma I-FABP concentration was higher in the enteral group than in the parenteral group at day 3 and day 8 (158 pg mL⁻¹ vs 50 pg mL⁻¹, p = 0.005 and 225 pg mL⁻¹ vs 50 pg mL⁻¹, p = 0.03).

Conclusion

Plasma citrulline concentration was higher after 3 days of enteral nutrition than after 3 days of parenteral nutrition. This result raises the question of the possibility that enteral nutrition is associated with a more rapid restoration of enterocyte mass than parenteral nutrition.

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Titel: Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial
verfasst von: Gaël Piton
Amélie Le Gouge
Noelle Brulé
Benoit Cypriani
Jean-Claude Lacherade
Saad Nseir
Jean-Paul Mira
Emmanuelle Mercier
Michel Sirodot
Jean-Philippe Rigaud
Stéphanie Malaquin
Edouard Soum
Michel Djibre
Stéphane Gaudry
Didier Thévenin
Jean Reignier
Publikationsdatum: 29.05.2019
Verlag: Springer Berlin Heidelberg
Erschienen in: Intensive Care Medicine / Ausgabe 7/2019
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05649-3

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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