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Caloric intake and the fat-to-carbohydrate ratio in hypercapnic acute respiratory failure: Post-hoc analysis of the PermiT trial.
Al-Dorzi, Hasan M; Aldawood, Abdulaziz S; Tamim, Hani; Haddad, Samir H; Jones, Gwynne; McIntyre, Lauralyn; Solaiman, Othman; Sakhija, Maram; Sadat, Musharaf; Afesh, Lara; Kumar, Anand; Bagshaw, Sean M; Mehta, Sangeeta; M Arabi, Yaseen.
Afiliación
  • Al-Dorzi HM; Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: aldorziha@NGHA.MED.SA.
  • Aldawood AS; Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: dawooda@ngha.med.sa.
  • Tamim H; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Department of Internal Medicine, American University of Beirut- Medical Center, Beirut, Lebanon. Electronic address: hani_t@hotmail.com.
  • Haddad SH; Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: haddads55@yahoo.com.
  • Jones G; Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada. Electronic address: GJones@ottawahospital.on.ca.
  • McIntyre L; Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Canada. Electronic address: lmcintyre@ottawahospital.on.ca.
  • Solaiman O; Department of Adult Critical Care, King Faisal Specialist Hospital and Research Center, Riyadh 11426, Saudi Arabia. Electronic address: omsmd@yahoo.com.
  • Sakhija M; Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: SakkijhaM@NGHA.MED.SA.
  • Sadat M; Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: sadatmu@ngha.med.sa.
  • Afesh L; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Electronic address: Afeshla@ngha.med.sa.
  • Kumar A; Health Sciences Centre, Manitoba, Canada. Electronic address: akumar61@yahoo.com.
  • Bagshaw SM; Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada. Electronic address: Sean.Bagshaw@albertahealthservices.ca.
  • Mehta S; Department of Medicine and Interdepartmental Division of Critical Care Medicine, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada. Electronic address: SMehta@mtsinai.on.ca.
  • M Arabi Y; Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Electronic address: yaseenarabi@yahoo.com.
Clin Nutr ESPEN ; 29: 175-182, 2019 02.
Article en En | MEDLINE | ID: mdl-30661684
BACKGROUND: The effect of moderate caloric enteral intake in critically ill patients with hypercapnic acute respiratory failure (HCARF) is unclear. We studied the impact of permissive underfeeding (PUF) compared with standard feeding (SF) on various HCARF outcomes. MATERIALS AND METHODS: The PermiT trial randomized 894 patients to either PUF (40-60% caloric requirement) or SF (70-100% requirement) with similar protein intake and found no difference in mortality, mechanical ventilation (MV) duration and ventilator-free days. In this post-hoc study, we restricted analysis to mechanically-ventilated patients with HCARF (PaCO2 >45 mmHg on the first two study days) and assessed the impact of trial interventions and fat-to-carbohydrate ratio on outcomes. RESULTS: One-hundred-twenty patients had HCARF (59 PUF and 61 SF, age 53.7 ± 17.8 years, body mass index 31.1 ± 11.2 kg/m2, Acute Physiology and Chronic Health Evaluation II score 21.7 ± 7.1 and day-1 PaCO2 61 ± 16 mmHg). Caloric intake was 815 ± 270 kcal/day in PUF group and 1289 ± 407 kcal/day in SF group. The two groups had similar PaCO2 levels during ICU stay. The 90-day mortality (33.9% versus 35.6%, p = 0.85), MV duration (10.7 ± 6.8 versus 11.1 ± 8.1 days, p = 0.56) and ventilator-free days (52.9 ± 38.6 versus 51.2 ± 38.0 days, p = 0.80) were also similar in PUF and SF groups, respectively. Ventilator-free days and 90-day mortality were similar when the fat-to-carbohydrate ratio was < or ≥ the median value (0.73) in all patients and in PUF and SF groups. CONCLUSIONS: In patients with HCARF, SF and PUF were associated with similar PaCO2, MV duration, ventilator-free days and mortality. Fat-to-carbohydrate ratio was not associated with mortality or ventilator-free days. TRIAL REGISTRATION: ISRCTN Registry: ISRCTN68144998.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Respiratoria / Ingestión de Energía / Carbohidratos / Grasas / Hipercapnia Tipo de estudio: Clinical_trials / Prognostic_studies Aspecto: Patient_preference Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Nutr ESPEN Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Insuficiencia Respiratoria / Ingestión de Energía / Carbohidratos / Grasas / Hipercapnia Tipo de estudio: Clinical_trials / Prognostic_studies Aspecto: Patient_preference Límite: Adult / Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Clin Nutr ESPEN Año: 2019 Tipo del documento: Article Pais de publicación: Reino Unido