O034 - LOW-METHOXY PECTIN-CONTAINING ENTERAL NUTRITION IN CRITICAL CARE FOR INTESTINAL TOLERANCE

O034

LOW-METHOXY PECTIN-CONTAINING ENTERAL NUTRITION IN CRITICAL CARE FOR INTESTINAL TOLERANCE

K. Nakamura^1,*, N. Yokoyama², S. Kashiwagi², R. Yamamoto³, S. Fujitani⁴, M. Yoshida⁵, Y. Takahashi⁶, J. Hatakeyama⁷

¹Division of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kobe, ²Department of Anesthesiology and Critical Care Medicine, Yokohama City University School of Medicine, Yokohama, ³Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, ⁴Department of Emergency and Critical Care Medicine, St.Marianna University School of Medicine, ⁵Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Kanagawa, ⁶Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Hitachi, ⁷Department of Emergency and Critical Care Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan

Rationale: Enteral nutrition is often interrupted due to diarrhea in critically ill patients. Low-methoxy pectin exerts antidiarrheal effects, however, whether the use of such formulations actually suppresses diarrhea is unclear.

Methods: This was a multicenter, parallel-group, open-label RCT conducted at 6 Japanese ICUs. We enrolled adult ICU patients receiving enteral nutrition and randomly assigned them to an intervention group receiving a pectin-containing formula or a control group receiving a pectin-free formula. Both formula contained 50% fat. Each group received the continuous intragastric administration of the assigned formula for at least three days. The occurrence of diarrhea as a Bristol stool scale score ≥5 within the first three days after the start of administration was evaluated as the primary outcome.

Results: A total of 203 patients were enrolled in this study, and 101 were randomized to the intervention group and 102 to the control group. The primary outcome of diarrhea occurred in 37 of 97 (38.1%) patients in the intervention group and 49 of 99 (49.5%) in the control group (p=0.11). When diarrhea was defined as a Bristol stool scale score ≥6, 29 (29.9%) patients in the intervention group and 45 (45.5%) in the control group had diarrhea, showing a significant reduction (p=0.02). There were no significant differences in the survival rate, lengths of ICU or hospital stays, duration of mechanical ventilation, the Barthel index at discharge, or the rate of enteral nutrition failure as secondary outcomes. There were no significant differences in adverse events with a causal relationship.

Conclusion: The low-methoxy pectin-containing enteral nutrition formula reduced diarrhea (Bristol stool scale score of 6–7) and did not increase adverse events in critically ill patients. Low methoxy pectin may be beneficial in ensuring appropriate nutritional support in critically ill patients.

Disclosure of Interest: K. Nakamura Grant / Research Support from: Otsuka Pharmaceutical Factory, Inc. (MF23-2), N. Yokoyama: None declared, S. Kashiwagi: None declared, R. Yamamoto: None declared, S. Fujitani: None declared, M. Yoshida: None declared, Y. Takahashi: None declared, J. Hatakeyama: None declared