• Gaël Piton, Amélie Le Gouge, Noelle Brulé, Benoit Cypriani, Jean-Claude Lacherade, Saad Nseir, Jean-Paul Mira, Emmanuelle Mercier, Michel Sirodot, Jean-Philippe Rigaud, Stéphanie Malaquin, Edouard Soum, Michel Djibre, Stéphane Gaudry, Didier Thévenin, and Jean Reignier.
• Medical Intensive Care Unit, CHRU Besançon, Besançon, France. gpiton@chu-besancon.fr.
• Intensive Care Med. 2019 Jul 1; 45 (7): 948-956.

PurposeThe effects of the route of nutrition on the gut mucosa of patients with shock are unclear. Plasma citrulline concentration is a marker of enterocyte mass, and plasma intestinal fatty acid binding protein (I-FABP) concentration is a marker of enterocyte damage. We aimed to study the effect of the route of nutrition on plasma citrulline concentration measured at day 3 of nutrition.Materials And MethodsAncillary study of the NUTRIREA-2 trial. Ventilated adults with shock were randomly assigned to receive enteral or parenteral nutrition. Enterocyte biomarkers were measured at baseline, day 3, and day 8 of nutrition.ResultA total of 165 patients from 13 French ICUs were included in the study: 85 patients in the enteral group and 80 patients in the parenteral group. At baseline, plasma citrulline was low without difference between groups (12.2 µmol L-1 vs 13.3 µmol L-1). At day 3, plasma citrulline concentration was higher in the enteral group than in the parenteral group (18.7 µmol L-1 vs 15.3 µmol L-1, p = 0.01). Plasma I-FABP concentration was increased at baseline, without difference between groups (245 pg mL-1 vs 244 pg mL-1). Plasma I-FABP concentration was higher in the enteral group than in the parenteral group at day 3 and day 8 (158 pg mL-1 vs 50 pg mL-1, p = 0.005 and 225 pg mL-1 vs 50 pg mL-1, p = 0.03).ConclusionPlasma citrulline concentration was higher after 3 days of enteral nutrition than after 3 days of parenteral nutrition. This result raises the question of the possibility that enteral nutrition is associated with a more rapid restoration of enterocyte mass than parenteral nutrition.

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