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Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial

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Abstract

Purpose

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.

Materials and methods

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.

Result

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).

Conclusion

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.

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Funding

The NUTRIREA-2 study was supported by a Grant from the French Ministry of Health, PHRCN-12-0184.

Author information

Authors and Affiliations

  1. Medical Intensive Care Unit, CHRU Besançon, Besançon, France

    Gaël Piton

  2. EA3920, Université de Franche Comté, Besançon, France

    Gaël Piton

  3. Inserm CIC 1415, Tours, France

    Amélie Le Gouge

  4. Université de Tours, Tours, France

    Amélie Le Gouge

  5. CHU Tours, Tours, France

    Amélie Le Gouge

  6. Médecine Intensive Réanimation, CHU de Nantes, Nantes, France

    Noelle Brulé & Jean Reignier

  7. Biochemistry Unit, Besançon University Hospital, Besançon, France

    Benoit Cypriani

  8. Médecine Intensive Réanimation, Centre Hospitalier Départemental de la Vendée, La Roche sur Yon, France

    Jean-Claude Lacherade

  9. Medical Intensive Care Unit, CHU Lille, Lille, France

    Saad Nseir

  10. Medicine School, Université Lille, Lille, France

    Saad Nseir

  11. Medical Intensive Care Unit, Cochin University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Jean-Paul Mira

  12. Médecine Intensive Réanimation, Hôpital Bretonneau, CHU Tours, Tours, France

    Emmanuelle Mercier

  13. Medical-Surgical Intensive Care Unit, Centre Hospitalier Annecy-Genevois, Metz-Tessy, Pringy, France

    Michel Sirodot

  14. Medical-Surgical Intensive Care Unit, Hôpital de Dieppe, Dieppe, France

    Jean-Philippe Rigaud

  15. Surgical Intensive Care Unit, CHU Amiens Picardie, Amiens, France

    Stéphanie Malaquin

  16. Medical Intensive Care Unit, Hôpital Gabriel Montpied, CHU de Clermont-Ferrand, Clermont-Ferrand, France

    Edouard Soum

  17. Medical-Surgical Intensive Care Unit, Tenon University Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Michel Djibre

  18. Medical-Surgical Intensive Care Unit, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Colombes, France

    Stéphane Gaudry

  19. Université Paris Diderot, ECEVE, UMR 1123, Sorbonne Paris Cité, Paris, France

    Stéphane Gaudry

  20. Medical-Surgical Intensive Care Unit, Centre Hospitalier Docteur Schaffner, Lens, France

    Didier Thévenin

  21. Université de Nantes, Nantes, France

    Jean Reignier

  22. Service de Réanimation Médicale, CHRU de Besançon, Boulevard Fleming, 25030, Besançon, France

    Gaël Piton

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  1. Gaël Piton
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Corresponding author

Correspondence to Gaël Piton.

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Conflicts of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study protocol was approved by the ethics committee of the French Intensive Care Society and appropriate French authorities.

Informed consent

According to French law, because the treatments and strategies used in the study were classified as standard care, there was no requirement for signed consent, but the patients or next of kin were informed about the study before enrolment and confirmed this fact in writing.

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134_2019_5649_MOESM1_ESM.jpg

Supplementary Data, Fig. 1. Flow chart of the study. Among the 2410 patients included in the NUTRIREA-2 trial, 165 patients from 13 French ICUs were included in this substudy: 85 patients in the enteral group and 80 patients in the parenteral group. (JPEG 23 kb)

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Piton, G., Le Gouge, A., Brulé, N. et al. Impact of the route of nutrition on gut mucosa in ventilated adults with shock: an ancillary of the NUTRIREA-2 trial. Intensive Care Med 45, 948–956 (2019). https://doi.org/10.1007/s00134-019-05649-3

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