A pilot study of alternative substrates in the critically Ill subject using a ketogenic feed

Angela McNelly, Anne Langan, Danielle E. Bear, Alexandria Page, Tim Martin, Fatima Seidu, Filipa Santos, Kieron Rooney, Kaifeng Liang, Simon J. Heales, Tomas Baldwin, Isabelle Alldritt, Hannah Crossland, Philip J. Atherton, Daniel Wilkinson, Hugh Montgomery, John Prowle, Rupert Pearse, Simon Eaton and Zudin A. Puthucheary ()
Additional contact information
Angela McNelly: Queen Mary University of London
Anne Langan: Adult Critical Care Unit, Royal London Hospital
Danielle E. Bear: Department of Nutrition and Dietetics, St Thomas’ NHS Foundation Trust
Alexandria Page: Royal London Hospital
Tim Martin: Royal London Hospital
Fatima Seidu: Royal London Hospital
Filipa Santos: Royal London Hospital
Kieron Rooney: Bristol Royal Infirmary
Kaifeng Liang: Queen Mary University of London
Simon J. Heales: UCL Great Ormond Street Institute of Child Health
Tomas Baldwin: UCL Great Ormond Street Institute of Child Health
Isabelle Alldritt: University of Nottingham
Hannah Crossland: University of Nottingham
Philip J. Atherton: University of Nottingham
Daniel Wilkinson: University of Nottingham
Hugh Montgomery: University College London (UCL)
John Prowle: Queen Mary University of London
Rupert Pearse: Queen Mary University of London
Simon Eaton: UCL Great Ormond Street Institute of Child Health
Zudin A. Puthucheary: Queen Mary University of London

Nature Communications, 2023, vol. 14, issue 1, 1-14

Abstract: Abstract Bioenergetic failure caused by impaired utilisation of glucose and fatty acids contributes to organ dysfunction across multiple tissues in critical illness. Ketone bodies may form an alternative substrate source, but the feasibility and safety of inducing a ketogenic state in physiologically unstable patients is not known. Twenty-nine mechanically ventilated adults with multi-organ failure managed on intensive care units were randomised (Ketogenic n = 14, Control n = 15) into a two-centre pilot open-label trial of ketogenic versus standard enteral feeding. The primary endpoints were assessment of feasibility and safety, recruitment and retention rates and achievement of ketosis and glucose control. Ketogenic feeding was feasible, safe, well tolerated and resulted in ketosis in all patients in the intervention group, with a refusal rate of 4.1% and 82.8% retention. Patients who received ketogenic feeding had fewer hypoglycaemic events (0.0% vs. 1.6%), required less exogenous international units of insulin (0 (Interquartile range 0-16) vs.78 (Interquartile range 0-412) but had slightly more daily episodes of diarrhoea (53.5% vs. 42.9%) over the trial period. Ketogenic feeding was feasible and may be an intervention for addressing bioenergetic failure in critically ill patients. Clinical Trials.gov registration: NCT04101071.

Date: 2023
References: View references in EconPapers View complete reference list from CitEc
Citations:

Downloads: (external link)
https://www.nature.com/articles/s41467-023-42659-8 Abstract (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:nat:natcom:v:14:y:2023:i:1:d:10.1038_s41467-023-42659-8

Ordering information: This journal article can be ordered from
https://www.nature.com/ncomms/

DOI: 10.1038/s41467-023-42659-8

Access Statistics for this article

Nature Communications is currently edited by Nathalie Le Bot, Enda Bergin and Fiona Gillespie

More articles in Nature Communications from Nature
Bibliographic data for series maintained by Sonal Shukla () and Springer Nature Abstracting and Indexing ().