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- Title
Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial.
- Authors
Piton, Gaël; Le Gouge, Amélie; Brulé, Noelle; Cypriani, Benoit; Lacherade, Jean-Claude; Nseir, Saad; Mira, Jean-Paul; Mercier, Emmanuelle; Sirodot, Michel; Rigaud, Jean-Philippe; Malaquin, Stéphanie; Soum, Edouard; Djibre, Michel; Gaudry, Stéphane; Thévenin, Didier; Reignier, Jean
- Abstract
<bold>Purpose: </bold>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.<bold>Materials and Methods: </bold>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.<bold>Result: </bold>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).<bold>Conclusion: </bold>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.
- Subjects
NUTRITION; MUCOUS membranes; PARENTERAL feeding; PROTEIN binding; CITRULLINE
- Publication
Intensive Care Medicine, 2019, Vol 45, Issue 7, p948
- ISSN
0342-4642
- Publication type
journal article
- DOI
10.1007/s00134-019-05649-3