The Effect of Enteral Immunonutrition in the Intensive Care Unit: Does It Impact on Outcomes?

Autor: Lopez-Delgado JC; Intensive Care Department, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n, 08907 L'Hospitalet de Llobregat, Spain.; IDIBELL (Institut d'Investigació Biomèdica Bellvitge, Biomedical Investigation Institute of Bellvitge), Av. de la Gran Via, 199, 08908 L'Hospitalet de Llobregat, Spain., Grau-Carmona T; Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain.; i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain., Trujillano-Cabello J; Intensive Care Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain.; IRBLLeida (Institut de Recerca Biomèdica de Lleida Fundació Doctor PiFarré, Lleida Biomedical Research Institute's Doctor PiFarré Foundation), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain., García-Fuentes C; Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain.; i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain., Mor-Marco E; Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Spain., Bordeje-Laguna ML; Intensive Care Department, Hospital Universitario Germans Trias i Pujol, Carretera de Canyet, s/n, 08916 Badalona, Spain., Portugal-Rodriguez E; Intensive Care Department, Hospital Clínico Universitario de Valladolid, Av. Ramón y Cajal, 3, 47003 Valladolid, Spain., Lorencio-Cardenas C; Intensive Care Department, Hospital Universitari Josep Trueta, Av. de França, s/n, 17007 Girona, Spain., Vera-Artazcoz P; Intensive Care Department, Hospital de la Santa Creu i Sant Pau, C/Sant Quintí, 89, 08041 Barcelona, Spain., Macaya-Redin L; Intensive Care Department, Complejo Hospitalario de Navarra, C/Irunlarrea, E, 31008 Pamplona, Spain., Martinez-Carmona JF; Intensive Care Department, Hospital Regional Universitario Carlos Haya, Av. de Carlos Haya, 84, 29010 Málaga, Spain., Mateu-Campos L; Intensive Care Department, Hospital General Universitario de Castellón, Avda. de Benicàssim, 128, 12004 Castelló de la Plana, Spain., Gero-Escapa M; Intensive Care Department, Hospital Universitario de Burgos, Av. Islas Baleares, 3, 09006 Burgos, Spain., Gastaldo-Simeon R; Intensive Care Department, Hospital de Manacor, Carretera Manacor-Alcudia, s/n, 07500 Manacor, Spain., Vila-García B; Intensive Care Department, Hospital Universitario Infanta Cristina, Av. 9 de Junio, 2, 28981 Parla, Spain., Flordelis-Lasierra JL; Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain.; i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain., Montejo-Gonzalez JC; Intensive Care Department, Hospital Universitario 12 de Octubre, Av. de Córdoba s/n, 28041 Madrid, Spain.; i+12 (Instituto de Investigación Sanitaria Hospital 12 de Octubre, Research Institute Hospital 12 de Octubre), Av. de Córdoba s/n, 28041 Madrid, Spain., Servia-Goixart L; Intensive Care Department, Hospital Universitari Arnau de Vilanova, Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain.; IRBLLeida (Institut de Recerca Biomèdica de Lleida Fundació Doctor PiFarré, Lleida Biomedical Research Institute's Doctor PiFarré Foundation), Av. Alcalde Rovira Roure, 80, 25198 Lleida, Spain., The Enpic Study Group
Jazyk: angličtina
Zdroj: Nutrients [Nutrients] 2022 May 01; Vol. 14 (9). Date of Electronic Publication: 2022 May 01.
DOI: 10.3390/nu14091904
Abstrakt: Background: The present research aimed to evaluate the effect on outcomes of immunonutrition (IMN) enteral formulas during the intensive care unit (ICU) stay. Methods: A multicenter prospective observational study was performed. Patient characteristics, disease severity, nutritional status, type of nutritional therapy and outcomes, and laboratory parameters were collected in a database. Statistical differences were analyzed according to the administration of IMN or other types of enteral formulas. Results: In total, 406 patients were included in the analysis, of whom 15.02% (61) received IMN. Univariate analysis showed that patients treated with IMN formulas received higher mean caloric and protein intake, and better 28-day survival (85.2% vs. 73.3%; p = 0.014. Unadjusted Hazard Ratio (HR): 0.15; 95% CI (Confidence Interval): 0.06−0.36; p < 0.001). Once adjusted for confounding factors, multivariate analysis showed a lower need for vasopressor support (OR: 0.49; 95% CI: 0.26−0.91; p = 0.023) and continuous renal replacement therapies (OR: 0.13; 95% CI: 0.01−0.65; p = 0.049) in those patients who received IMN formulas, independently of the severity of the disease. IMN use was also associated with higher protein intake during the administration of nutritional therapy (OR: 6.23; 95% CI: 2.59−15.54; p < 0.001), regardless of the type of patient. No differences were found in the laboratory parameters, except for a trend toward lower triglyceride levels (HR: 0.97; 95% CI: 0.95−0.99; p = 0.045). Conclusion: The use of IMN formulas may be associated with better outcomes (i.e., lower need for vasopressors and continuous renal replacement), together with a trend toward higher protein enteral delivery during the ICU stay. These findings may ultimately be related to their modulating effect on the inflammatory response in the critically ill. NCT Registry: 03634943.
Databáze: MEDLINE
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