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ESPEN ASPENESPEN guidelines on
Parenteral Nutrition:
intensive care, Clinical
Nutrition 2009; 28: 387-400
Guidelines for the provision
and assessment of nutrition
support therapy in the adult
critically ill patient: SCCM and
ASPEN: Executive Summary. Crit
ESPEN ASPENNutrition 2009; 28: 387-400
ASPEN: Executive Summary. Crit
Care Med 2009; 37: 1757–61.
Canadian clinical practice guidelines for nutrition
support in mechanically ventilated, critically ill adult
patients. J Parenter Enteral Nutr 2003; 27: 355–73.
Introduction
• Mortality rate is higher with the use of:
- early PN alone
- early use of combined PN with EN
Does enteral nutrition compared to parenteral nutrition result
in better outcomes in critically ill adult patients?
A systematic review of the literature. Nutrition 2004; 20: 843–48.
Introduction
• Tight Calorie Control study (TICACOS)
- Lower hospital discharge mortality
- More infections
- Longer time on mechanical ventilation
The tight calorie control study (TICACOS): a prospective,
randomized, controlled pilot study of nutritional support
in critically ill patients. Intensive Care Med 2011;
37: 601–09.
Optimisation of energy
provision with
Supplemental Parenteral Nutrition
in critically ill patients:
A randomized controlled
clinical trial
R3 謝智凱
陳奇祥主任
clinical trial
Methods
• Switzerland
- Geneva University hospital.
- Lausanne University hospital.
• Mixed medical and surgical ICUs.
Exclusion Criteria
• Exclusion:
- Receiving PN
- Persistent GI dysfunction
- Ileus
- Pregnant
- Readmission
• Care providers and patients were not masked.
Trial Design
• EN formula: 1.05-1.62 kcal/ml.
• PN formula: 0.62-1.37 kcal/ml.
• Continuous IV insulin therapy: <8.5 mmol/L
Trial Endpoints
• Occurrence of nosocomial infections after day 8
until day 28.
- Pneumonia
- Bloodstream infection
- Urogenital infection- Urogenital infection
- Abdominal infection
- Others
Trial Endpoints
• Antibiotic days for nosocomial infection.
• Antibiotic free days.
• Duration of invasive and non-invasive
mechanical ventilation.
• Length of stay in ICU and hospital.• Length of stay in ICU and hospital.
Results
Mean energy delivery:
EN: 20kcal/kg
SPN: 28 kcal/kg
Mean cumulative energy balance
EN: 124 kcal
SPN: - 2317kcalSPN: - 2317kcal
Secondary outcomes
• Alkaline Phosphatase concentrations lower in
SPN group (2.01 vs 2.75, p=0.0131).
• Decreased of CRP more in SPN group
(959.54 nmol/L vs 667.44 nmol/L, p=0.0180)
Discussion
• Delivery of near 100% of energy supply with an
SPN approach can effectively decrease infections
and antibiotic use.
Discussion
• Mortality rate is higher with the use of:
- early PN alone
- early use of combined PN with EN
Does enteral nutrition compared to parenteral nutrition result
in better outcomes in critically ill adult patients?
A systematic review of the literature. Nutrition 2004; 20: 843–48.
Discussion
• Tight Calorie Control study (TICACOS)
- Lower hospital discharge mortality
- More infections
- Longer time on mechanical ventilation
The tight calorie control study (TICACOS): a prospective,
randomized, controlled pilot study of nutritional support
in critically ill patients. Intensive Care Med 2011;
37: 601–09.