Attenuating Inflammation via Protein-Calorie Restriction

通过限制蛋白质热量减轻炎症

基本信息

批准号：
7913067
负责人：
TODD W RICE
金额：
$ 15.19万
依托单位：
VANDERBILT UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-30 至 2012-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7913067
关键词：
Abdomen Academic Medical Centers Acute respiratory failure Address Adherence Advanced Development Animal Model Animals Anti-Inflammatory Agents Anti-inflammatory Arginine Aspiration Pneumonia Atrophic Attenuated Bacteremia Bacteria Bacterial Translocation Benefits and Risks Biochemical Biometry Blood flow Bolus Infusion Burn Trauma C-reactive protein Caloric Restriction Clinical Clinical Research Clinical Trials Design Closed head injuries Collaborations Communities Complication Conduct Clinical Trials Conflict (Psychology)Coupled Critical Care Critical Illness Data Development Doctor of Medicine Enrollment Enteral Enteral Feeding Enteral Nutrition Enterobacteriaceae Epidemiology Epithelial Epithelial Cells Equilibrium Feeds Foundations Functional disorder Future Gastrointestinal Motility Glutamine Growth Homeostasis Hyperglycemia IL8 gene Immune Immunoglobulin A Immunosuppression Incidence Infection Inflammation Inflammation Mediators Inflammatory Inflammatory Response Inflammatory Response Pathway Intensive Care Intensive Care Units Interleukin-1 Interleukin-10 Interleukin-4 Interleukin-6 Intestinal Mucosa Intestines Ischemic Bowel Disease Laboratories Length of Stay Leukotrienes Measures Mechanical ventilation Mediator of activation protein Medical Mentors Messenger RNA Nausea and Vomiting Nosocomial Infections Nosocomial pneumonia Nutritional Support Omega-3 Fatty Acids Operative Surgical Procedures Organ Organ failure Outcome Parenteral Nutrition Patient Recruitments Patients Physicians Physiology Population Heterogeneity Procedures Production Prostaglandins Proteins Randomized Randomized Clinical Trials Randomized Controlled Trials Reporting Research Research Personnel Residual state Residual volume Resolution Resources Rice Risk Safety Serum Stimulus Stomach Structure Systemic infection Techniques Tight Junctions Tumor Necrosis Factor-alpha Tumor Necrosis Factors Ventilator Weaning aging population arm bile salts career cellular microvillus clinical practice cost cytokine design feeding gastrointestinal improved in vivo inflammatory marker lipid metabolism nutrition outcome forecast patient population prevent prognostic prospective response skills trial comparing

项目摘要

DESCRIPTION (provided by applicant): The purpose of this proposal is to cultivate the scientific development and advance the skills of Dr. Todd W. Rice in the design and conduct of clinical trials, so that he may become an independent investigator in conducting clinical research. Vanderbilt University Medical Center, through its several intensive care units, will provide Dr. Rice with the necessary patient population to conduct a prospective, randomized clinical trial comparing the effects of trophic nutrition versus advancement to full-calorie rates in mechanically ventilated, critically ill patients. Laboratory resources are available to investigate changes in biochemical responses, including pro- and anti-inflammatory cytokine responses. Differences in clinical outcomes, including weaning patients from the ventilator, will be assessed. Through collaboration with his clinical mentor, Dr. Arthur P. Wheeler, Dr. Rice will become adept at trial design, biostatistics, epidemiology, patient recruitment, and reporting of results to the scientific community. These skills will provide the foundation for Dr. Rice to pursue an independent academic career in critical care research. Many mechanically ventilated patients, unable to nourish themselves, are provided with nutrition, either enterally or parenterally. Enteral nutrition has been shown to reduce inflammation and improve clinical outcomes by preserving the intestinal mucosa, decreasing bacterial translocation, and reducing systemic infections. Although these improvements have been observed with full enteral feedings, very low rates of enteral feedings show similar protection in animals. We hypothesize that these low-level feedings also preserve the intestinal mucosa in ventilated patients, while reducing the pro- and anti-inflammatory cytokine responses seen in these patients along with the gastrointestinal complications, resulting in improved clinical outcomes compared to full-calorie feeds. The specific aims of this proposal are to demonstrate that low-level as compared to full-calorie enteral feedings will: 1) decrease the early pro-inflammatory and compensatory anti-inflammatory cytokine responses; 2) decrease the incidence of feeding complications, and thus, 3) improve clinical outcomes, such as ventilator-free days and other organ-failure free days. The aging population, increasing immunosuppression, and rising use of invasive procedures will result in the continued growth of critical care. Many mechanically ventilated, critically ill patients are supported with enteral nutrition. Despite widespread use, data on optimal delivery of enteral nutrition to such patients is lacking. This proposal will help weigh the benefits and risks, establish a cost-efficient means of reducing feeding complications, and provide the foundation for future studies of enteral feeds in patients with acute respiratory failure requiring mechanical ventilation.

描述（由申请人提供）：该提案的目的是培养科学发展并提高Todd W. Rice博士在设计和进行临床试验方面的技能，使他能够成为进行临床研究的独立研究者。范德比尔特大学医学中心将通过其多个重症监护病房为莱斯博士提供必要的患者群体，以进行一项前瞻性、随机临床试验，比较机械通气危重患者营养营养与全热量摄入的效果。实验室资源可用于研究生化反应的变化，包括促炎和抗炎细胞因子反应。将评估临床结果的差异，包括患者脱离呼吸机的情况。通过与他的临床导师 Arthur P. Wheeler 博士合作，Rice 博士将擅长试验设计、生物统计学、流行病学、患者招募以及向科学界报告结果。这些技能将为莱斯博士在重症监护研究领域追求独立的学术生涯奠定基础。许多机械通气患者无法自我营养，只能通过肠内或肠外途径获得营养。肠内营养已被证明可以通过保护肠粘膜、减少细菌移位和减少全身感染来减少炎症并改善临床结果。尽管在完全肠内喂养的情况下观察到了这些改善，但极低的肠内喂养率在动物中显示出类似的保护作用。我们假设这些低水平喂养还可以保护机械通气患者的肠粘膜，同时减少这些患者的促炎和抗炎细胞因子反应以及胃肠道并发症，从而与全热量喂养相比改善临床结果。该提案的具体目的是证明，与全热量肠内喂养相比，低水平喂养将：1）减少早期促炎和代偿性抗炎细胞因子反应； 2) 降低喂养并发症的发生率，因此，3) 改善临床结果，例如无呼吸机日和无其他器官衰竭日。老龄化人口的增加、免疫抑制的增加以及侵入性手术的使用增加将导致重症监护的持续增长。许多机械通气的危重患者接受肠内营养支持。尽管广泛使用，但仍缺乏向此类患者提供最佳肠内营养的数据。该提案将有助于权衡利益和风险，建立一种减少喂养并发症的经济有效的方法，并为未来对需要机械通气的急性呼吸衰竭患者进行肠内喂养的研究奠定基础。

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Hyperoxia is associated with increased mortality in patients treated with mild therapeutic hypothermia after sudden cardiac arrest.

DOI：
10.1097/ccm.0b013e3182656976
发表时间：
2012-12
期刊：
Critical care medicine
影响因子：
8.8
作者：
Janz DR;Hollenbeck RD;Pollock JS;McPherson JA;Rice TW
通讯作者：
Rice TW

Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure.

DOI：
10.1097/ccm.0b013e31820a905a
发表时间：
2011-05
期刊：
Critical care medicine
影响因子：
8.8
作者：
Rice TW;Mogan S;Hays MA;Bernard GR;Jensen GL;Wheeler AP
通讯作者：
Wheeler AP

Randomized trial of automated, electronic monitoring to facilitate early detection of sepsis in the intensive care unit*.

DOI：
10.1097/ccm.0b013e318250a887
发表时间：
2012-07
期刊：
Critical care medicine
影响因子：
8.8
作者：
Hooper MH;Weavind L;Wheeler AP;Martin JB;Gowda SS;Semler MW;Hayes RM;Albert DW;Deane NB;Nian H;Mathe JL;Nadas A;Sztipanovits J;Miller A;Bernard GR;Rice TW
通讯作者：
Rice TW

Can we stomach gastric feeding in critically ill patients with gastrointestinal intolerance?

胃肠道不耐受的重症患者可以胃饲吗？