GI - Nutritional Support - The Eastern Association for the Surgery of Trauma

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Eastern Association for the Surgery of Trauma

GI - Nutritional Support

Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines.

Reintam Blaser A, Starkopf J, Alhazzani W, Berger MM, Casaer MP, Deane AM, Fruhwald S, Hiesmayr M, Ichai C, Jakob SM, Loudet CI, Malbrain ML, Montejo González JC, Paugam-Burtz C, Poeze M, Preiser JC, Singer P, van Zanten AR, De Waele J, Wendon J, Wernerman J, Whitehouse T, Wilmer A, Oudemans-van Straaten HM; ESICM Working Group on Gastrointestinal Function.

Intensive Care Med. 2017 Mar;43(3):380-398.

Rationale for inclusion: This is a very recent CPG from ESICM. It has 17 recommendations using the GRADE format, with 5 meta-analyses covering TBI, severe acute pancreatitis, GI procedures, abdominal trauma, and the general ICU population.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

A multicentre, randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of early nutritional support via the parenteral versus the enteral route in critically ill patients (CALORIES).

Harvey SE, Parrott F, Harrison DA, Sadique MZ, Grieve RD, Canter RR, McLennan BK, Tan JC, Bear DE, Segaran E, Beale R, Bellingan G, Leonard R, Mythen MG, Rowan KM.

Health Technol Assess. 2016 Apr;20(28):1-144.

Rationale for inclusion: The CALORIES trial is likely the largest of its kind, with 1200 patients in each arm. Patients were studied for the first week of their ICU stay (randomized within 36 hours of admission to a 5-day trial of early nutritional support via either parenteral or enteral routes. 30-day mortality and 90-day net cost benefit were the primary outcomes; no change in mortality, slightly higher cost in the TPN arm. It's a long read with excellent discussion and references.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Recent Critical Care Nutrition Trials and the Revised Guidelines: Do They Reconcile?

McCarthy MS, Warren M, Roberts PR.

Nutr Clin Pract. 2016 Apr;31(2):150-4.

Rationale for inclusion: Good summary of the most important nutrition trials since the 2016 ASPEN guidelines (which stopped including studies in December 2013). Includes analysis of the CALORIES trial. GRADE methodology was used.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Probiotics in human medicine.

Fuller R.

Gut. 1991 Apr;32(4):439-42.

Rationale for inclusion: This is a good historical review (at the dawn of the medical probiotic era) of altering the human microbiome with therapeutic intent. References cited in this paper go back as far as 1921.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

TEN versus TPN following major abdominal trauma -reduced septic morbidity.

Moore FA, Moore EE, Jones TN, McCroskey BL, Peterson VM.

J Trauma. 1989 Jul;29(7):916-22; discussion 922-3.

Rationale for inclusion: This paper (and the succeeding Adams et al paper) are two of the earliest trials addressing early enteral (via jejunostomy) nutrition in patients undergoing trauma laparotomy. This trial (the later of the two) showed mortality and infection benefit in a small (46 pts) single center trial.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Enteral versus parenteral nutritional support following laparotomy for trauma: a randomized prospective trial.

Adams S, Dellinger EP, Wertz MJ, Oreskovich MR, Simonowitz D, Johansen K.

J Trauma. 1986 Oct;26(10):882-91.

Rationale for inclusion: This paper (and the preceding Adams et al paper) are two of the earliest trials addressing early enteral (via jejunostomy) nutrition in patients undergoing trauma laparotomy. This trial (the earlier of the two) showed no mortality or infection benefit in a small (60 pts) single center trial. The goal appears to have been to establish non-inferiority with parenteral nutrition.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.

Guidelines for total parenteral nutrition.

Shils ME.

JAMA. 1972 Jun 26;220(13):1721-9.

Rationale for inclusion: This is the first set of guidelines published for TPN (in 1972!), though there are papers documenting parenteral infusion of varying combinations of fats, proteins, carbohydrates, and even alcohols in humans since the 1940's.

Citations - To review the number of citations for this landmark paper, visit Google Scholar.