RT Journal Article
SR Electronic
T1 Multimodal nutritional rehabilitation improves clinical outcomes of malnourished patients with chronic respiratory failure: a randomised controlled trial
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 953
OP 960
DO 10.1136/thx.2010.154922
VO 66
IS 11
A1 Pison, Christophe M
A1 Cano, Noël J
A1 Chérion, Cécile
A1 Caron, Fabrice
A1 Court-Fortune, Isabelle
A1 Antonini, Marie-Thérèse
A1 Gonzalez-Bermejo, Jésus
A1 Meziane, Lahouari
A1 Molano, Luis Carlos
A1 Janssens, Jean-Paul
A1 Costes, Frédéric
A1 Wuyam, Bernard
A1 Similowski, Thomas
A1 Melloni, Boris
A1 Hayot, Maurice
A1 Augustin, Julie
A1 Tardif, Catherine
A1 Lejeune, Hervé
A1 Roth, Hubert
A1 Pichard, Claude
A1 ,
YR 2011
UL http://thorax.bmj.com/content/66/11/953.abstract
AB Background In chronic respiratory failure (CRF), body composition strongly predicts survival.Methods A prospective randomised controlled trial was undertaken in malnourished patients with CRF to evaluate the effects of 3 months of home rehabilitation on body functioning and composition. 122 patients with CRF on long-term oxygen therapy and/or non-invasive ventilation (mean (SD) age 66 (10) years, 91 men) were included from eight respiratory units; 62 were assigned to home health education (controls) and 60 to multimodal nutritional rehabilitation combining health education, oral nutritional supplements, exercise and oral testosterone for 90 days. The primary endpoint was exercise tolerance assessed by the 6-min walking test (6MWT). Secondary endpoints were body composition, quality of life after 3 months and 15-month survival.Results Mean (SD) baseline arterial oxygen tension was 7.7 (1.2) kPa, forced expiratory volume in 1 s 31 (13)% predicted, body mass index (BMI) 21.5 (3.9) kg/m2 and fat-free mass index (FFMI) 15.5 (2.4) kg/m2. The intervention had no significant effect on 6MWT. Improvements (treatment effect) were seen in BMI (+0.56 kg/m2, 95% CI 0.18 to 0.95, p=0.004), FFMI (+0.60 kg/m2, 95% CI 0.15 to 1.05, p=0.01), haemoglobin (+9.1 g/l, 95% CI 2.5 to 15.7, p=0.008), peak workload (+7.2 W, 95% CI 3.7 to 10.6, p<0.001), quadriceps isometric force (+28.3 N, 95% CI 7.2 to 49.3, p=0.009), endurance time (+5.9 min, 95% CI 3.1 to 8.8, p<0.001) and, in women, Chronic Respiratory Questionnaire (+16.5 units, 95% CI 5.3 to 27.7, p=0.006). In a multivariate Cox analysis, only rehabilitation in a per-protocol analysis predicted survival (HR 0.27, 95% CI 0.07 to 0.95, p=0.042).Conclusions Multimodal nutritional rehabilitation aimed at improving body composition increased exercise tolerance, quality of life in women and survival in compliant patients, supporting its incorporation in the treatment of malnourished patients with CRF.Clinical Trial number NCT00230984.