ESPEN 2012 - Late breaking abstract submission

Topic: Late Breaking Abstract

Abs n°:ESPEN12-1928

Abs Title: IMPACT OF EARLY PARENTERAL NUTRITION ON MUSCLE VOLUME AND INTEGRITY DURING THE FIRST WEEK OF CRITICAL ILLNESS.

M. P. Casaer ^1,*L. Langouche ¹W. Coudyzer ²D. Van Beckevoort ²B. De Dobbelaer ²F. G. Guiza ¹P. Wouters ¹D. Mesotten ¹G. Van den Berghe ¹

¹Department and laboratory of Intensive Care Medicine, Catholic University Leuven, ²Department of Radiology, University Hospitals Leuven, Leuven, Belgium

Rationale: The goal of enhanced nutrition in critically ill patients is to improve outcome by reducing lean tissue wasting. However such effect has not been proven¹. In the EPaNIC trial, withholding parenteral nutrition (PN) early in critical illness [Late PN] as compared to initiating PN when enteral nutrition was insufficient [Early PN], prevented infections and accelerated recovery despite substantial nutritional deficit². This study assessed the effect of both interventions on muscle volume and integrity by quantitative computer tomography (qCT).

Methods: In 15 EPaNIC patients requiring repeated CT for neurosurgical reasons and 6 healthy volunteers matched for age, gender and BMI, abdominal and femoral qCT images were obtained in a standardized manner on day 2±1 and day 7±1. Fat and muscle volumes were quantified based on their prespecified Hounsfield Unit (HU) ranges. Intramuscular, subcutaneous and visceral fat compartments were delineated manually. The changes in volumes and integrity, reflected by infiltration of water and fat into the muscular compartment (HU), were compared by paired t-tests in the 3 studied groups.

Results: The inter- and intra-observer CV’s showed high accuracy and reproducibility. The loss of femoral muscle volume during the first week of critical illness was unaffected by Early or Late PN. Moreover, in the Early PN group, femoral muscle integrity decreased. Intramuscular adipose isles increased in the Early, but not in the Late PN group and correlated with the change in muscle integrity. In the abdominal compartments, changes were similar.

Conclusion: Early PN does not prevent the dramatic early muscle wasting observed in ICU, provokes loss of muscular integrity and increases the volume of adipose tissue isles within the muscle. Analysis of EPaNIC muscle biopsies will allow identifying the nature of these changes.

Reference(s): ¹ Streat SJ ea, J Trauma 1987
² Casaer MP ea, NEJM 2011

Disclosure of Interest: M. Casaer: None DeclaredL. Langouche: None DeclaredW. Coudyzer: None DeclaredD. Van Beckevoort: None DeclaredB. De Dobbelaer: None DeclaredF. Guiza: None DeclaredP. Wouters: None DeclaredD. Mesotten: None DeclaredG. Van den Berghe Grant/Research Support from: Unrestricted and non-conditional grant from Baxter to KULeuven for the EPaNIC trial

Keywords: Body compositionCritical care nutrition