title: Tolerability and efficacy of a low-volume enteral supplement containing key nutrients in the critically ill.
abstract: OBJECTIVE
  To compare early supplementation with antioxidants and glutamine using a low-volume enteral supplement containing key nutrients to an energy adjusted standard elementary diet and to investigate its effect on clinical efficacy and tolerability in critically ill patients with sepsis/SIRS. The primary endpoints were length of stay in the ICU and sufficient enteral feed.
  
  
  METHODS
  This was a randomized, prospective, single-blind, controlled study in 58 critically ill patients (56.9% male, mean age 46.7 years, mean APACHE II score 21.6). They received either a low-volume enteral supplement containing key nutrients or a diluted standard nutrition solution. After 10 or 14 days inflammatory parameters, catecholamine need, and maximal enteral delivery were determined.
  
  
  RESULTS
  Patients receiving a low-volume enteral supplement containing key nutrients did not reach sufficient enteral feed more often than controls (76 vs. 62%, respectively, p = 0.17). The difference in vitamin E and selenium uptake was higher in the treatment group than controls (12.4 vs. 3.7 and 54.7 vs. 16.3, respectively, p ≤ 0.011). Parameters such as fever, antibiotic treatment, artificial ventilation, and death were comparable. This was also true for days of ICU or hospital stay (33 ± 23 and 49 ± 34 days, respectively).
  
  
  CONCLUSIONS
  The low-volume enteral supplement containing key nutrients was well tolerated and led to a better vitamin E and selenium supply. However, it did not affect length of ICU or hospital stay. Further studies are necessary to determine which disease-specific subgroups may benefit from this supplementation or which group may be harmed.
authors.affiliation: Department of Gastroenterology, Hepatology and Endocrinology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany. andrea.s.schneider@gmx.de
authors.forename: Andrea
authors.initials: A
authors.lastname: Schneider
authors.forename: Andrea
authors.initials: A
authors.lastname: Markowski
authors.forename: Michael
authors.initials: M
authors.lastname: Momma
authors.forename: Claudia
authors.initials: C
authors.lastname: Seipt
authors.forename: Birgit
authors.initials: B
authors.lastname: Luettig
authors.forename: Johannes
authors.initials: J
authors.lastname: Hadem
authors.forename: Michaela
authors.initials: M
authors.lastname: Wilhelmi
authors.forename: Michael P
authors.initials: MP
authors.lastname: Manns
authors.forename: Jochen
authors.initials: J
authors.lastname: Wedemeyer
mesh_terms: D000328:Adult; D000975:Antioxidants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D016638:Critical Illness; D002149:Energy Intake; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005334:Fever / Q000150:complications / Q000209:etiology / Q000517:prevention & control; D005526:Food, Formulated / Q000009:adverse effects / Q000032:analysis; D005973:Glutamine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D012643:Selenium / Q000008:administration & dosage; D018805:Sepsis / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D016037:Single-Blind Method; D018746:Systemic Inflammatory Response Syndrome / Q000150:complications / Q000503:physiopathology* / Q000628:therapy; D014810:Vitamin E / Q000008:administration & dosage
chemical_list: D000975:Antioxidants; D005973:Glutamine; D014810:Vitamin E; D012643:Selenium