112 Poster presentations
with less hypoglycemia (2% SPRINT vs 7.7% and 2.9% for Glucontrol-A,B). SPRINT had less BG<3.0 mmol/L and less hyperglycemia (BG>8.0 mmol/L).
Conclusion: Protocols that dose insulin “blind” to carbohydrate administration suffer greater glycemic variability, even if cohort-wide glycemic targets are met. TGC protocols must be explicitly designed to account for carbohydrate administration to minimise BG variability and thus mortality outcomes across cohorts and/or centres.
Disclosure of Interest:None declared
PP228
SUPPLEMENTAL PARENTERAL NUTRITION (SPN) IN ICU PATIENTS FOR EARLY COVERAGE OF ENERGY TARGET: SECOND PRELIMINARY REPORT OF A BI-CENTRIC, PROSPECTIVE, CONTROLLED, RANDOMIZED STUDY
R. Thibault1, C.P. Heidegger2, S. Graf1, M. Marin Caro1,
P. Darmon1, V. Brancato3, M.M. Berger3, C. Pichard1. 1Unit´e de Nutrition,2Intensive Care, Geneva University
Hospital, Geneva,3Intensive Care, University Hospital
Center (CHUV), Lausanne, Switzerland
Rationale: Enteral nutrition (EN) does not achieve targeted nutritional goals in ICU patients. The study investigates the feasibility to deliver 100% of the energy and protein target from day 4 after admission by SPN.
Methods: The inclusion criteria were mean energy delivery of the 3 first days<60% of predicted energy target (ESPEN guidelines), length of stay >5 days, expected survival>7 days, no contraindication to EN, patients not receiving PN, age>18 y. We included 211 patients, then excluded 26 patients; 185 patients were randomized to receive EN alone (“EN group”, n = 99) according to local practice, or EN+SPN (“SPN group”, n = 86) consisting in using PN to reach the energy target if EN is insufficient. Energy target was adjusted by indirect calorimetry in 64% of patients. Protein target was calculated as 1.3 g/kg actual body weight/day.
Results:At inclusion, EN and SPN groups were similar for age (mean±SD, 60±16 vs 62±16), gender (79/30 men vs 76/26), BMI (26.5±4.5 vs 26.4±4.4) and SOFA (7±3 vs 6±4). Patients were admitted for cardiogenic shock (30%), sepsis (19%), trauma injury (15%), brain surgery (12%) and other diagnosis (24%).
Energy (ED) and protein (PD) delivery, expressed as mean±SD (% target)
ED d4 PD d4
ED d5 PD d5
ED d6 PD d6
ED d7 PD d7
ED d8 PD d8
ED d4 8 PD d4 8
EN (n = 99) 62±31 52±28
70±34 58±31
76±32 64±30
81±34 68±33
77±32 62±27
72±24 60±23 SPN (n = 86) 96±25
85±27
101±22 90±24
102±28 89±27
99±26 84±27
97±34 85±30
98±17 86±18 P value* <0.0001 <0.0001 <0.0001 <0.001 <0.0001 <0.0001
*EN vs. SPN for ED and PD; d, day.
Conclusion:EN alone delays the delivery of the energy target in ICU patients. SPN allows covering the energy target within the first 24 hours and can be successfully implemented in ICU patients. The available industrial PN
solutions do not allow a full coverage of protein target in ICU patients.
Disclosure of Interest:None declared
PP229
IMPLEMENTATION OF THE CURRENT PRE-OPERATIVE FASTING GUIDELINES, HAS IT BEEN SUCCESSFUL? AN AUDIT OF CURRENT PRACTICE
J.A. Stephenson1, R. Jadavji1, M. Patel1, O. Al-Taan1,
D. Al-Leswas1, C. Pollard1, M.S. Metcalfe1,
A.R. Dennison1.1Dept of Hepatobiliary & Pancreatic
Surgery, University Hospitals of Leicester, Leicester, United Kingdom
Rationale:In patients without disorders of gastric emp-tying undergoing elective surgery it is unnecessary and undesirable to restrict access to clear, non-particulate fluids for more than two hours prior to induction of anaesthesia. This practice is recommended by the national UK GIFTASUP guidelines. The evidence comes from a Cochrane review of 22 trials in which a reduction of the period of pre-operative fasting failed to alter the volume or pH of gastric secretions significantly. Despite this many patients are still made nil by mouth (NBM) from midnight for ease of nursing care.
Methods:We conducted a prospective audit of all surgical patients undergoing a general surgical procedure requir-ing a general anaesthetic usrequir-ing a structured questionnaire over a 20 day period. Day case procedures were excluded.
Results: 75 patients were followed through the peri-operative period with 41 elective and 34 emergency cases identified from theatre records.
The average pre-operative NBM period for clear liquids was 16 hours. This was 14 hours in the elective group and 19 hours in the emergency group. Zero patients in the elective group had clear fluids 2 hours prior to induction of anaesthesia and only 2 (5%) patients in this group had clear fluids between 2 and 6 hours prior to anaesthesia.
Conclusion:Our results show that we do not adhere to guidance and best evidence. With the advent of enhanced recovery programs and an emphasis on early enteral feeding post-operatively to maintain ‘normal’ physiology we appear to have forgotten about the pre-operative period.
Surgical teams, anaesthetists and nurses need educating about the guidelines and practice changed in keeping with available evidence to benefit patients.
Disclosure of Interest:None declared
PP230
IMMUNOMODULATORY EFFECTS OF CITRULLINE ON BACTERIAL TRANSLOCATION IN MICE
M.A. Batista1, M.I.T.D. Correia2, V.N. Cardoso1. 1Pharmacy School,2Surgery, Medical School,
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
