Six-month outcomes after traumatic brain injury in the Augmented versus Routine Approach to Giving Energy multicentre, double-blind, randomised controlled Trial (TARGET).

IF 2.6 3区 医学 Q2 CRITICAL CARE MEDICINE Australian Critical Care Pub Date : 2024-10-10 DOI:10.1016/j.aucc.2024.09.001
Kym Wittholz, Kate Fetterplace, Lee-Anne Chapple, Emma J Ridley, Mark Finnis, Jeffrey Presneill, Marianne Chapman, Sandra Peake, Rinaldo Bellomo, Amalia Karahalios, Adam M Deane
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Abstract

Background: Critically ill patients with a traumatic brain injury (TBI) may require prolonged intensive care unit (ICU) admission and hence receive greater exposure to hospital enteral nutrition. It is unknown if augmented energy delivery with enteral nutrition during ICU admission impacts quality of life in survivors or gastrointestinal tolerance during nutrition delivery in the ICU.

Objectives: The objective of this study was to compare health-related quality of life, using the EuroQol five-dimensions five-level visual analogue scale at 6 months, in survivors who presented with a TBI and received augmented energy (1.5 kcal/ml) to those who received routine energy (1.0 kcal/ml). Secondary objectives were to explore differences in total energy and protein delivery, gastrointestinal tolerance, and mortality between groups.

Methods: Secondary analysis of participants admitted with a TBI in the Augmented versus Routine Approach to Giving Energy Trial (TARGET) randomised controlled trial. Data are represented as n (%) or median (interquartile range).

Results: Of the 3957 patients in TARGET, 231 (5.8%) were admitted after a TBI (augmented = 124; routine = 107). Patients within TARGET who were admitted with a TBI were relatively young (42 [27, 61] years) and received TARGET enteral nutrition for an extended period (9 [5, 15] days). At 6 months, EuroQol five-dimensions five-level quality-of-life scores were available for 166 TBI survivors (72% of TBI cohort randomised, augmented = 97, routine = 69). There was no evidence of a difference in quality of life (augmented = 70 [52, 90]; routine = 70 [55, 85]; median difference augmented vs routine = 0 [95% confidence interval: -5, 10]). TBI participants assigned to augmented energy received more energy with a similar protein than the routine group. Gastrointestinal tolerance was similar between groups.

Conclusion: While patients admitted after a TBI received enteral nutrition for an extended period, an increased exposure to augmented energy did not affect survivors' quality-of-life scores.

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多中心、双盲、随机对照试验(TARGET)中脑外伤后 6 个月的疗效。
背景:创伤性脑损伤(TBI)重症患者可能需要长期入住重症监护室(ICU),因此需要接受更多的医院肠内营养。在入住重症监护室期间使用肠内营养增加能量输送是否会影响幸存者的生活质量或重症监护室营养输送期间的胃肠道耐受性,目前尚不清楚:本研究的目的是使用 EuroQol 五维度五级视觉类比量表,比较创伤性脑损伤幸存者在 6 个月后与常规能量(1.0 千卡/毫升)相关的健康生活质量。次要目标是探讨各组之间在总能量和蛋白质输送、胃肠道耐受性和死亡率方面的差异:对随机对照试验(TARGET)中因创伤性脑损伤入院的参与者进行二次分析。数据以n(%)或中位数(四分位数间距)表示:结果:在 TARGET 的 3957 名患者中,有 231 人(5.8%)在发生创伤性脑损伤后入院(增强型=124 人;常规=107 人)。因创伤性脑损伤入院的 TARGET 患者相对年轻(42 [27, 61] 岁),接受 TARGET 肠内营养的时间较长(9 [5, 15] 天)。6 个月后,166 名创伤性脑损伤幸存者(占创伤性脑损伤随机组群的 72%,增强 = 97,常规 = 69)的 EuroQol 五维度五级生活质量评分结果出炉。没有证据表明生活质量存在差异(增强型 = 70 [52, 90];常规型 = 70 [55, 85];增强型与常规型的中位数差异 = 0 [95% 置信区间:-5, 10])。与常规组相比,接受增能治疗的创伤性脑损伤患者获得的蛋白质能量更多。各组的胃肠道耐受性相似:结论:虽然创伤性脑损伤后入院的患者需要长期接受肠内营养,但增加能量摄入并不会影响幸存者的生活质量评分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Australian Critical Care
Australian Critical Care NURSING-NURSING
CiteScore
4.90
自引率
9.10%
发文量
148
审稿时长
>12 weeks
期刊介绍: Australian Critical Care is the official journal of the Australian College of Critical Care Nurses (ACCCN). It is a bi-monthly peer-reviewed journal, providing clinically relevant research, reviews and articles of interest to the critical care community. Australian Critical Care publishes peer-reviewed scholarly papers that report research findings, research-based reviews, discussion papers and commentaries which are of interest to an international readership of critical care practitioners, educators, administrators and researchers. Interprofessional articles are welcomed.
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