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Potential benefits of using an energy-dense, high-protein formula enriched with ß-hydroxy-ß-methylbutyrate, fructo-oligosaccharide, and vitamin D for enteral feeding in the ICU: A pilot case-control study in COVID-19 patients.
Cereda, Emanuele; Guzzardella, Amedeo; Tamayo, Leonor; Piano, Marco; Alquati, Omar; Vadalà, Rocco; Resta, Marco Vittorio; Balzarini, Anna; Tavola, Mario; Ripamonti, Clara; Cerri, Marco; Pennacchio, Nadia; Cozzi, Silvano; Crotti, Silvia; Masi, Sara; Grasselli, Giacomo; Caccialanza, Riccardo.
  • Cereda E; Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy. Electronic address: e.cereda@smatteo.pv.it.
  • Guzzardella A; Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Department of Anesthesia, Critical Care and Emergency and University of Milan, Department of Pathophysiology and Transplantation Milano, Italy.
  • Tamayo L; Azienda Ospedaliera Istituti Ospedalieri, Cremona, Italy.
  • Piano M; Azienda Ospedaliera Istituti Ospedalieri, Cremona, Italy.
  • Alquati O; Anesthesia and ICU Department Maggiore Hospital ASST Lodi, Lodi, Italy.
  • Vadalà R; Anesthesia and ICU Department Maggiore Hospital ASST Lodi, Lodi, Italy.
  • Resta MV; Anaesthesia and Critical Care Department, IRCCS San Donato Milanese Policlinic, San Donato Milanese, Milan, Italy.
  • Balzarini A; Anaesthesia and Critical Care Department, IRCCS San Donato Milanese Policlinic, San Donato Milanese, Milan, Italy.
  • Tavola M; SC Anestesia E Rianimazione, ASST-Lecco, Lecco, Italy.
  • Ripamonti C; SC Anestesia E Rianimazione, ASST-Lecco, Lecco, Italy.
  • Cerri M; Department of Neurocritical Care, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
  • Pennacchio N; Department of Neurocritical Care, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
  • Cozzi S; Department of Neurocritical Care, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.
  • Crotti S; Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Masi S; Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
  • Grasselli G; Fondazione IRCCS Ca' Granda Ospedale Maggiore di Milano Policlinico, Department of Anesthesia, Critical Care and Emergency and University of Milan, Department of Pathophysiology and Transplantation Milano, Italy.
  • Caccialanza R; Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
Nutrition ; 106: 111901, 2022 Nov 02.
Artículo en Inglés | MEDLINE | ID: covidwho-2228665
ABSTRACT

OBJECTIVES:

The aim of this study was to investigate the potential benefits of using an energy-dense, high-protein (HP) formula enriched with ß-hydroxy-ß-methylbutyrate (HMB), fructo-oligosaccharide (FOS), and vitamin D (VitD) for enteral feeding in the intensive care unit (ICU).

METHODS:

This was a nested case-control multicenter study. Mechanically ventilated patients with COVID-19 in whom enteral nutrition was not contraindicated and receiving an energy-dense, HP-HMB-FOS-VitD formula (1.5 kcal/mL; 21.5% of calories from protein; n = 53) were matched (11) by age (±1 y), sex, body mass index (±1 kg/m2) and Sequential Organ Failure Assessment score (±1 point) and compared with patients fed with a standard HP, fiber-free formula (1.25-1.3 kcal/mL; 20% of calories from protein; n = 53). The primary end point was daily protein intake (g/kg) on day 4. Protein-calorie intake on day 7, gastrointestinal intolerance, and clinical outcomes were addressed as secondary end points.

RESULTS:

The use of a HP-HMB-FOS-VitD formula resulted in higher protein intake on days 4 and 7 (P = 0.006 and P = 0.013, respectively), with similar energy intake but higher provision of calories from enteral nutrition at both times (P <0 .001 and P = 0.017, respectively). Gastrointestinal tolerance was superior, with fewer patients fed with a HP-HMB-FOS-VitD formula reporting at least one symptom of intolerance (55 versus 74%; odds ratio [OR], 0.43; 95% confidence interval [CI], 0.18-0.99; P = 0.046) and constipation (38 versus 66%; OR, 0.27; 95% CI, 0.12-0.61; P = 0.002). A lower rate of ICU-acquired infections was also observed (42 versus 72%; OR, 0.29; 95% CI, 0.13-0.65; P = 0.003), although no difference was found in mortality, ICU length of stay, and ventilation-free survival.

CONCLUSIONS:

An energy-dense, HP-HMB-FOS-VitD formula provided a more satisfactory protein intake and a higher provision of caloric intake from enteral nutrition than a standard HP formula in mechanically ventilated patients with COVID-19. Lower rates of gastrointestinal intolerance and ICU-acquired infections were also observed.
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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Tipo de estudio: Estudio experimental / Estudio observacional / Estudio pronóstico Idioma: Inglés Revista: Nutrition Asunto de la revista: Ciencias Nutricionales Año: 2022 Tipo del documento: Artículo

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Texto completo: Disponible Colección: Bases de datos internacionales Base de datos: MEDLINE Tipo de estudio: Estudio experimental / Estudio observacional / Estudio pronóstico Idioma: Inglés Revista: Nutrition Asunto de la revista: Ciencias Nutricionales Año: 2022 Tipo del documento: Artículo