The human gut microbiome is truly mind-boggling. We are teaming with microorganisms and their presence has been implicated not just in C. difficile colitis but in obesity, cardiovascular disease and a whole host of other diseases. The suggestion has even been made that our genetic code should be described as not only the DNA found within our cells, but as an amalgamation of that and the genes found in the microorganisms that surround and cover us – that the microorganisms are an intrinsic part of ‘us’.
The EDEN trial is one of the go-to trials for feeding in the ICU. The paper can be found here, but essentially it recruited 1000 patients with respiratory failure, comparing different calorie targets for a period of 6 days. One group received 25% of requirements (the trophic feeding group), with the other aiming for full requirements (receiving 80% of goal).* The primary outcome was ventilator free days to day 28, with the study powered to detect a 2.25 day difference. 60 day mortality was a secondary outcome.
As far as complications go, anastomotic leak after emergency bowel surgery is not to be recommended. The early identification of a leak is crucial. C-Reactive Protein (CRP) has been suggested as a marker that may be useful to identifying this complication, but the question is whether it is useful in the case of the high risk emergency laparotomy in the critical care environment.
Whether all critically ill patients need the routine administration of stress ulcer prophylaxis (SUP) has been controversial for over 20 years. Much of the evidence both for and against is of poor quality, and is pretty old.
The TRICC trial has reassured us that allowing a Hb of >7 is acceptable (and probably beneficial) in the critically ill. Bleeding patients were excluded from that study however, and critical care evidence based practice rarely translates to a change outside of the ICU. It is as if critical care is somehow a different world!
The paper to be discussed compared a liberal transfusion trigger (of 9g/dl) to a restrictive strategy of 7g/dl in patients with UGI bleeding.
So long as you don’t overfeed, providing enteral nutrition is a good thing to do. It provides nutrients, and maintains gut integrity.* (For a review of why the latter is hugely important in critical care click here)
This is a collection of blog posts written about new research or topics of interest.
This site is written for healthcare professionals. Nothing on it constitutes medical advice, and opinions expressed are those of the authors.
Dr Peter Hersey & Dr Laura O'Connor