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Critical Care
Published in: Critical Care 4/2013

01-08-2013 | Viewpoint

Does artificial nutrition improve outcome of critical illness? An alternative viewpoint!

Authors: Daren K Heyland, Paul E Wischmeyer

Published in: Critical Care | Issue 4/2013

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Abstract

Recent studies challenge the beneficial role of artificial nutrition provided to critically ill patients and point out the limitations of existing studies in this area. We take a differing view of the existing data and refute many of the arguments put forward by previous authors. We review the mechanistic, observational, and experimental data supporting a role for early enteral nutrition in the critically ill patient. We conclude without question that more, high-quality research is needed to better define the role of artificial nutrition in the critical care setting, but until then early and adequate delivery of enteral nutrition is a legitimate, evidence-based treatment recommendation and we see no evidence-based role for restricting enteral nutrition in critically ill patients. The role of early supplemental parenteral nutrition continues to be defined as new data emerge.
Literature
1.
Heyland DK, Heyland J, Dhaliwal R, Madden S, Cook D: Randomized trials in critical care nutrition: look how far we've come! (And where do we go from here?). JPEN J Parenter Enteral Nutr 2010, 34: 697-706. 10.1177/0148607110362993PubMedCrossRef
2.
3.
McClave SA, Heyland DK: The physiologic response and associated clinical benefits from provision of early enteral nutrition. Nutr Clin Pract 2009, 24: 305-315. 10.1177/0884533609335176PubMedCrossRef
4.
5.
6.
Griffiths RD, Hall JB: Intensive care unit-acquired weakness [review]. Crit Care Med 2010, 38: 779-787. 10.1097/CCM.0b013e3181cc4b53PubMedCrossRef
7.
Masiero E, Agatea L, Mammucari C, Blaauw B, Loro E, Komatsu M, Metzger D, Reggiani C, Schiaffino S, Sandri M: Autophagy is required to maintain muscle mass. Cell Metab 2009, 10: 507-515. 10.1016/j.cmet.2009.10.008PubMedCrossRef
8.
Gunst J, Derese I, Aertgeerts A, Ververs EJ, Wauters A, Van den Berghe G, Vanhorebeek I: Insufficient autophagy contributes to mitochondrial dysfunction, organ failure, and adverse outcome in an animal model of critical illness. Crit Care Med 2013, 41: 182-194. 10.1097/CCM.0b013e31828e928dPubMedCrossRef
9.
Vanhorebeek I, Gunst J, Derde S, Derese I, Boussemaere M, Guiza F, Martinet W, Timmermans JP, D'Hoore A, Wouters PJ, Van den Berghe G: Insufficient activation of autophagy allows cellular damage to accumulate in critically ill patients. J Clin Endocrinol Metab 2011, 96: E633-E645. 10.1210/jc.2010-2563PubMedCrossRef
10.
van der Vos KE, Eliasson P, Proikas-Cezanne T, Vervoort SJ, van Boxtel R, Putker M, van Zutphen IJ, Mauthe M, Zellmer S, Pals C, Verhagen LP, Groot Koerkamp MJ, Braat AK, Dansen TB, Holstege FC, Gebhardt R, Burgering BM, Coffer PJ: Modulation of glutamine metabolism by the PI(3)K-PKB-FOXO network regulates autophagy. Nat Cell Biol 2012, 14: 829-837. 10.1038/ncb2536PubMedCrossRef
11.
Sakiyama T, Musch MW, Ropeleski MJ, Tsubouchi H, Chang EB: Glutamine increases autophagy under basal and stressed conditions in intestinal epithelial cells. Gastroenterology 2009, 136: 924-932. 10.1053/j.gastro.2008.12.002PubMedPubMedCentralCrossRef
12.
Heyland DK, Muscedere J, Wischmeyer P, Cook D, Jones G, Albert M, Elke G, Berger MM, Day AG, for the Canadian Critical Care Trials Group: A randomized trial of glutamine and antioxidants in critically ill patients. N Engl J Med 2013, 368: 1489-1497. 10.1056/NEJMoa1212722PubMedCrossRef
13.
Alberda C, Gramlich L, Jones N, Jeejeebhoy K, Day AG, Dhaliwal R, Heyland DK: The relationship between nutritional intake and clinical outcomes in critically ill patients: results of an international multicenter observation study. Intensive Care Med 2009, 35: 1728-1737. 10.1007/s00134-009-1567-4PubMedCrossRef
14.
Heyland DK, Cahill N, Day AG: Optimal amount of calories for critically ill patients: depends on how you slice the cake! Crit Care Med 2011, 39: 2619-2626.PubMedCrossRef
15.
16.
Martin CM, Doig GS, Heyland DK, Morrison T, Sibbald WJ, Southwestern Ontario Critical Care Research Network: Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ 2004, 170: 197-204.PubMedPubMedCentral
17.
Taylor SJ, Fettes SB, Jewkes C, Nelson RJ: Prospective, randomized, controlled trial to determine the effect of early enhanced enteral nutrition on clinical outcome in mechanically ventilated patients suffering head injury. Crit Care Med 1999, 27: 2525-2531. 10.1097/00003246-199911000-00033PubMedCrossRef
18.
Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, Morris A, Dong N, Rock P: Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA 2012, 307: 795-803.PubMedCrossRef
19.
Arabi YM, Tamim HM, Dhar GS, Al-Dawood A, Al-Sultan M, Sakkijha MH, Kahoul SH, Brits R: Permissive underfeeding and intensive insulin therapy in critically ill patients: a randomized controlled trial. Am J Clin Nutr 2011, 93: 569-577. 10.3945/ajcn.110.005074PubMedCrossRef
20.
Heyland DK, Dhaliwal R, Jiang X, Day AG: Identifying critically ill patients who benefit the most from nutrition therapy: the development and initial validation of a novel risk assessment tool. Crit Care 2011, 15: R268. 10.1186/cc10546PubMedPubMedCentralCrossRef
21.
Casaer MP, Mesotten D, Hermans G, Wouters PJ, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C, Meersseman P, Muller J, Vlasselaers D, Debaveye Y, Desmet L, Dubois J, Van Assche A, Vanderheyden S, Wilmer A, Van den Berghe G: Early versus late parenteral nutrition in critically ill adults. N Engl J Med 2011, 365: 506-517. 10.1056/NEJMoa1102662PubMedCrossRef
22.
Casaer MP, Wilmer A, Hermans G, Wouters PJ, Mesotten D, Van den Berghe G: Role of disease and macronutrient dose in the randomized controlled EPaNIIC trial: a post hoc analysis. Am J Respir Crit Car Med 2013, 187: P247-P255. 10.1164/rccm.201206-0999OCCrossRef
23.
Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, Thibault R, Pichard C: Optimization of energy provision with supplemental parenteral nutrition in critically ill patients: a randomized controlled clinical trial. The Lancet 2012. Lancet 2013, 381:385-93
24.
Metadata
Title
Does artificial nutrition improve outcome of critical illness? An alternative viewpoint!
Authors
Daren K Heyland
Paul E Wischmeyer
Publication date
01-08-2013
Publisher
BioMed Central
Published in
Critical Care / Issue 4/2013
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc12701

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