ABSTRACTS from 16th International COnference on ... - CRRT Online

Nutritional Support in ICU Patients: Does Timing and Route Matter?
Miet Schetz MD, PhD
1:45-2:00
Wednesday, February 15
Educational Objectives:
1. present the results of a large RCT on the timing of parenteral in addition to insufficient enteral nutrition in
ICU patients
2. explain potential mechanisms underlying the results
Content Description:
A large randomized trial in 4640 ICU patients compared early versus late addition of parenteral nutrition to
insufficient enteral nutrition. Late initiation of parenteral nutrition was associated with shorter ICU and hospital
stay, faster recovery of organ failure, fewer (mainly infectious) complications and reduced costs. Mortality was
not different. Potential mechanisms will be discussed.
Suggested Reading:
1.Casaer MP, Mesotten D, Hermans G, Wouters P, Schetz M, Meyfroidt G, Van Cromphaut S, Ingels C,
Meerseman Ph, 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. New Engl J med 2011;
365: 506-17
2.McClave SA, Martindale RG, Vanek VW, McCarthy M, Roberts P, Taylor B, Ochoa JB, Napolitano L, Cresci
G; A.S.P.E.N. Board of Directors; American College of Critical Care Medicine; Society of Critical Care
Medicine. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill
Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition
(A.S.P.E.N.). JPEN 2009; 33:277-316
3.Kreymann KG, Berger MM, Deutz NE, Hiesmayr M, Jolliet P, Kazandjiev G, Nitenberg G, van den Berghe G,
Wernerman J; DGEM (German Society for Nutritional Medicine), Ebner C, Hartl W, Heymann C, Spies C;
ESPEN (European Society for Parenteral and Enteral Nutrition). ESPEN Guidelines on Enteral Nutrition:
Intensive care. Clin Nutr. 2006; 25: 210-23
4.Singer P, Berger MM, Van den Berghe G, Biolo G, Calder P, Forbes A, Griffiths R, Kreyman G, Leverve X,
Pichard C, ESPEN. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr. 2009; 28: 387-400
5.Vanhorebeek I, Gunst J, Derde S, Derese I, Boussemaere M, Güiza 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: E633-45
6.Cuervo AM, Macian F. Autophagy, nutrition and immunology. Mol Aspects Med. 2012; 33: 2-13
7.Mizushima N, Komatsu M. Autophagy: renovation of cells and tissues. Cell. 2011; 147: 728-41
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