- Journal
- INTENSIVE CARE MEDICINE
- Année
- 2019
- Volume
- 45
- Numéro
- 7
- Pages
- 948-956
- Mois
- JUL
- DOI
- 10.1007/s00134-019-05649-3
Abstract
PurposeThe effects of the route of nutrition on the gut mucosa of patients with shock are unclear. Plasma citrulline concentration is a marker of enterocyte mass, and plasma intestinal fatty acid binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to study the effect of the route of nutrition on plasma citrulline concentration measured at day3 of nutrition.Materials and methodsAncillary study of the NUTRIREA-2 trial. Ventilated adults with shock were randomly assigned to receive enteral or parenteral nutrition. Enterocyte biomarkers were measured at baseline, day3, and day8 of nutrition.ResultA total of 165 patients from 13 French ICUs were included in the study: 85 patients in the enteral group and 80 patients in the parenteral group. At baseline, plasma citrulline was low without difference between groups (12.2 mu molL(-1) vs 13.3 mu molL(-1)). At day3, plasma citrulline concentration was higher in the enteral group than in the parenteral group (18.7 mu molL(-1) vs 15.3 mu molL(-1), p=0.01). Plasma I-FABP concentration was increased at baseline, without difference between groups (245pgmL(-1) vs 244pgmL(-1)). Plasma I-FABP concentration was higher in the enteral group than in the parenteral group at day3 and day8 (158pgmL(-1) vs 50pgmL(-1), p=0.005 and 225pgmL(-1) vs 50pgmL(-1), p=0.03).ConclusionPlasma citrulline concentration was higher after 3days of enteral nutrition than after 3days of parenteral nutrition. This result raises the question of the possibility that enteral nutrition is associated with a more rapid restoration of enterocyte mass than parenteral nutrition.