Trial reportMedizinische Klinik, Intensivmedizin und Notfallmedizin2013
Enteral nutrition is associated with improved outcome in patients with severe sepsis. A secondary analysis of the VISEP trial.
Trial report in Medizinische Klinik, Intensivmedizin und Notfallmedizin, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 4 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 4 syntheses or guidelines pooled it, 51 citations in OpenAlex.
- Role of probiotic supplementation in preventing ventilator-associated pneumonia among critically ill patients-a critical umbrella review of meta-analyses of randomized controlled trials.Frontiers in nutrition · 2025Pooled it
- Synbiotic Therapy Prevents Nosocomial Infection in Critically Ill Adult Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials Based on a Bayesian Framework.Frontiers in medicine · 2021Pooled it
- Enteral versus parenteral nutrition and enteral versus a combination of enteral and parenteral nutrition for adults in the intensive care unit.The Cochrane database of systematic reviews · 2018Pooled it
- Nutrition support in hospitalised adults at nutritional risk.The Cochrane database of systematic reviews · 2017Pooled it
- Early versus delayed enteral nutrition in septic shock: a target trial emulation study.Frontiers in nutrition · 2026Article
- Protein and Energy Intake Assessment and Their Association With In-Hospital Mortality in Critically Ill COVID-19 Patients: A Prospective Cohort Study.Frontiers in nutrition · 2021Article
- Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non-Septic ICU Patients on Prolonged Mechanical Ventilation: The PROCASEPT Retrospective Study.JPEN. Journal of parenteral and enteral nutrition · 2020Article
- AAST Critical Care Committee clinical consensus: ECMO, nutrition.Trauma surgery & acute care open · 2019Article
- Targeted Energy Intake Is the Important Determinant of Clinical Outcomes in Medical Critically Ill Patients with High Nutrition Risk.Nutrients · 2018Article
- Moderate glucose supply reduces hemolysis during systemic inflammation.Journal of inflammation research · 2018Article
- Effects of early enteral nutrition on T helper lymphocytes of surgical septic patients: A retrospective observational study.Medicine · 2017Observational
- Considerations When Using Predictive Equations to Estimate Energy Needs Among Older, Hospitalized Patients: A Narrative Review.Current nutrition reports · 2017Article
- Early traditional Chinese medicine bundle therapy for the prevention of sepsis acute gastrointestinal injury in elderly patients with severe sepsis.Scientific reports · 2017Observational
- Updates in Nutrition Support for Critically Ill Adult Patients.Hospital pharmacy · 2017Article
- [Enteral and/or parenteral nutrition in the critically ill : An algorithm as a possible basis for decision-making].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2016Review
- Maintaining Enteral Nutrition in the Severely Ill using a Newly Developed Nasojejunal Feeding Tube with Gastric Decompression Function.Internal medicine (Tokyo, Japan) · 2016Article
- The nutritional energy to clinical outcome relation revisited.Critical care (London, England) · 2014Article
Corrections and comments
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Authors and funding
10 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionThe optimal nutritional strategy remains controversial, particularly in severely septic patients. Our aim was to analyze the effect of three nutritional strategies--enteral (EN), parenteral (PN), and combined nutrition (EN+PN)--on the outcome of patients with severe sepsis or septic shock. PATIENTS AND
methodsThis secondary analysis of the prospective, randomized-controlled, multicenter "Intensive Insulin Therapy and Pentastarch Resuscitation in Severe Sepsis (VISEP)" trial only included patients with a length of stay in the intensive care unit (ICU) of more than 7 days. Besides patient characteristics, data on nutrition therapy were collected daily for up to 21 days. Morbidity as measured by the mean Sequential Organ Failure Assessment (SOFA) score, incidence of secondary infections, renal replacement therapy, ventilator-free days and severe hypoglycemia, length of ICU stay, and mortality at 90 days were compared between the three nutritional strategies.
resultsIn all, 353 patients were included in the analysis with the majority (68.5 %) receiving EN+PN, 24.4 % receiving EN, and only 7.1 % receiving PN. Median caloric intake was 918 kcal/day (EN), 1,210 kcal/day (PN), and 1,343 kcal/day (EN+PN; p < 0.001). In the latter group, calories were predominantly administered via the parenteral route within the first week. The rate of death at 90 days was lower with EN than with EN+PN (26.7 % vs. 41.3 %, p = 0.048), as was the rate of secondary infections, renal replacement therapy, and duration of mechanical ventilation. In the adjusted Cox regression analysis, the effect on mortality [hazard ratio (HR)= 1.86, 95 % confidence interval (CI): 1.16-2.98, p = 0.010] and the rate of secondary infections (HR= 1.89, 95 % CI: 1.27-2.81, p = 0.002) remained different between EN and EN+PN.
conclusionIn patients with severe sepsis or septic shock and prolonged ICU stay, EN alone was associated with improved clinical outcome compared to EN+PN. This hypothesis-generating result has to be confirmed by a randomized-controlled trial in this specific patient population.
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