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

Author

Listed:
  • 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
    Guy’s and St. Thomas’ NHS)

  • 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)
    National Institute for Health Research (NIHR) Biomedical Research Centre (BRC))

  • John Prowle

    (Queen Mary University of London
    Royal London Hospital)

  • Rupert Pearse

    (Queen Mary University of London
    Royal London Hospital)

  • Simon Eaton

    (UCL Great Ormond Street Institute of Child Health)

  • Zudin A. Puthucheary

    (Queen Mary University of London
    Royal London Hospital)

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.

Suggested Citation

  • 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 & Ha, 2023. "A pilot study of alternative substrates in the critically Ill subject using a ketogenic feed," Nature Communications, Nature, vol. 14(1), pages 1-14, December.
    • Handle: RePEc:nat:natcom:v:14:y:2023:i:1:d:10.1038_s41467-023-42659-8
    DOI: 10.1038/s41467-023-42659-8
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    1. Fotios Karagiannis & Konrad Peukert & Laura Surace & Marcel Michla & Fabian Nikolka & Mario Fox & Patricia Weiss & Caroline Feuerborn & Paul Maier & Susanne Schulz & Burcu Al & Benjamin Seeliger & Tob, 2022. "Impaired ketogenesis ties metabolism to T cell dysfunction in COVID-19," Nature, Nature, vol. 609(7928), pages 801-807, September.
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