Study sheds light on critical care nutrition 

12/11/2014 00:00 
A study involving senior clinicians and patients from UCLH has helped researchers to solve a long unanswered question about providing nutrition to critically ill patients.
Image of ciritical care ward 

UCLH was the top recruiting site in the CALORIES trial, which investigated the optimum route for providing nutrition to critically ill patients by comparing enteral feeding (a small tube passed into the stomach via the nose or mouth) with parenteral feeding (a small tube in a vein directly into the bloodstream).
Results showed there was no significant difference, despite the enteral route being the mainstay of nutritional support in critical care, and the parenteral route historically being associated with more risks and complications. The study involved more than 2,000 patients in 33 NHS hospitals and the result paves the way for new studies to address the dose and timing of nutritional support in patients in intensive care units.
Professor Monty Mythen, Honorary Consultant, anaesthesia and critical care at UCLH, was lead clinical investigator. Dr Geoff Bellingan, medical director and critical care consultant at UCLH was one of the clinical co-investigators; and Dr David Brealey, consultant lead for critical care trials at UCLH, was the local principal investigator. The study was supported by the Comprehensive Biomedical Research Centre (CBRC), a partnership between UCLH, University College London (UCL) and the National Institute for Health Research.
For a period of five days following admission to intensive care, 1,200 patients received tube feeding and 1,200 patients received intravenous feeding. Patients’ energy targets were set at 25 kcal per kilogram of actual body weight per day, with a goal of reaching the target within 48-72 hours. Researchers found caloric intake was similar in the two groups and there were no significant differences in mortality or in the mean number of treated infectious complications.
Malnutrition is a common problem in critically ill patients, and makes patients vulnerable to complications, such as infection. Early nutritional support is used to address both deficiencies in nutritional state and related disorders in metabolism.  Patients who are unable to eat adequate amounts of food are given special liquid diets which contain all the essential nutrients they need.
Recent improvements in the delivery, formulation and monitoring of the parenteral route justify further comparison and evaluation of these nutritional support techniques, particularly in the early phase of illness.
The research, published in the New England Journal of Medicine, saw collaboration between three London Academic Health Science Centres (AHSCs) – partnerships between healthcare providers and universities – at UCLP, Kings Health Partners and Imperial College.
Dr David Brealey said: "We are proud to have been a top recruiting site in such an important trial. It would not have been possible without the Comprehensive Local Research Networks and UCLH's ongoing commitment to research at the bedside.”
The research was funded by the NIHR Health Technology Assessment (HTA) programme, the largest of the NIHR programmes which has been running for over 20 years. HTA funds research relating to the effectiveness, costs and broader impact of healthcare treatments and tests for those who plan, provide or receive care in the NHS.

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