Journal Article

Impact of nutrition route on microaspiration in critically ill patients with shock: a planned ancillary study of the NUTRIREA-2 trial

Jaillette, Emmanuelle, Reignier, Jean, Mira, Jean-Paul, Nseir, Saad, Zerimech, Farid, Piton, Gaël, Coupez, Elisabeth, Pasco, Jeremy, Balduyck, Malika, Gaudry, Stéphane, Tinturier, François, Sirodot, Michel, Djibré, Michel, Mercier, Emmanuelle, Declercq, Pierre-Louis, Lascarrou, Jean-Baptiste, Le Gouge, Amélie, Lacherade, Jean-Claude, Thevenin, Didier

2019

Overview

Background Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions. Methods Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial. Patients with shock receiving invasive mechanical ventilation were randomized to receive early enteral or parenteral nutrition. All tracheal aspirates were collected during the 48 h following randomization. Abundant microaspiration of gastric contents and oropharyngeal secretions was defined as the presence of significant levels of pepsin (> 200 ng/ml) and salivary amylase (> 1685 UI/ml) in > 30% of tracheal aspirates. Results A total of 151 patients were included (78 and 73 patients in enteral and parenteral nutrition groups, respectively), and 1074 tracheal aspirates were quantitatively analyzed for pepsin and amylase. Although vomiting rate was significantly higher (31% vs 15%, p  = 0.016), constipation rate was significantly lower (6% vs 21%, p  = 0.010) in patients with enteral than in patients with parenteral nutrition. No significant difference was found regarding other patient characteristics. The percentage of patients with abundant microaspiration of gastric contents was significantly lower in enteral than in parenteral nutrition groups (14% vs 36%, p  = 0.004; unadjusted OR 0.80 (95% CI 0.69, 0.93), adjusted OR 0.79 (0.76, 0.94)). The percentage of patients with abundant microaspiration of oropharyngeal secretions was significantly higher in enteral than in parenteral nutrition groups (74% vs 54%, p  = 0.026; unadjusted OR 1.21 (95% CI 1.03, 1.44), adjusted OR 1.23 (1.01, 1.48)). No significant difference was found in percentage of patients with ventilator-associated pneumonia between enteral (8%) and parenteral (10%) nutrition groups (HR 0.78 (0.26, 2.28)). Conclusions Our results suggest that enteral and parenteral nutrition are associated with high rates of microaspiration, although oropharyngeal microaspiration was more common with enteral nutrition and gastric microaspiration was more common with parenteral nutrition. Trial registration ClinicalTrials.gov, NCT03411447 . Registered 18 July 2017. Retrospectively registered.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Aged / Amylases / Analysis / Bacteria / Bodily Secretions / Care and treatment / Clinical trials / Constipation / Critical care / Critical Care Medicine / Critical Illness - therapy / Drug Administration Routes / Emergency Medicine / Female / Food and Nutrition / Gastric contents / Gastric Juice / Humans / Inhalation - physiology / Intensive / Intensive care / Intensive Care Units - organization & administration / Intensive Care Units - statistics & numerical data / Life Sciences / Male / Medical research / Medicine / Medicine & Public Health / Microaspiration / Middle Aged / Mortality / Nutrition / Nutrition Therapy - instrumentation / Nutrition Therapy - methods / Nutrition Therapy - standards / Oropharyngeal secretions / Parenteral nutrition / Pathophysiology / Pneumonia / Respiratory tract diseases / Retrospective Studies / Santé publique et épidémiologie / Shock / Shock - diet therapy / Time Factors