eprintid: 10184236 rev_number: 6 eprint_status: archive userid: 699 dir: disk0/10/18/42/36 datestamp: 2023-12-20 15:48:00 lastmod: 2023-12-20 15:48:00 status_changed: 2023-12-20 15:48:00 type: article metadata_visibility: show sword_depositor: 699 creators_name: McNelly, Angela creators_name: Langan, Anne creators_name: Bear, Danielle E creators_name: Page, Alexandria creators_name: Martin, Tim creators_name: Seidu, Fatima creators_name: Santos, Filipa creators_name: Rooney, Kieron creators_name: Liang, Kaifeng creators_name: Heales, Simon J creators_name: Baldwin, Tomas creators_name: Alldritt, Isabelle creators_name: Crossland, Hannah creators_name: Atherton, Philip J creators_name: Wilkinson, Daniel creators_name: Montgomery, Hugh creators_name: Prowle, John creators_name: Pearse, Rupert creators_name: Eaton, Simon creators_name: Puthucheary, Zudin A title: A pilot study of alternative substrates in the critically Ill subject using a ketogenic feed ispublished: pub divisions: UCL divisions: B02 divisions: C10 divisions: D17 divisions: D13 divisions: G22 divisions: G94 keywords: Drug development, Phase I trials, Translational research note: This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/. 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: 2023-12-15 date_type: published publisher: Springer Science and Business Media LLC official_url: http://dx.doi.org/10.1038/s41467-023-42659-8 oa_status: green full_text_type: pub language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 2134066 doi: 10.1038/s41467-023-42659-8 pii: 10.1038/s41467-023-42659-8 lyricists_name: Montgomery, Hugh lyricists_name: Eaton, Simon lyricists_id: HEMON01 lyricists_id: SEATO65 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner funding_acknowledgements: Educational grant [Baxter International Inc. | Baxter Healthcare Corporation] full_text_status: public publication: Nature Communications volume: 14 number: 1 article_number: 8345 event_location: England citation: McNelly, Angela; Langan, Anne; Bear, Danielle E; Page, Alexandria; Martin, Tim; Seidu, Fatima; Santos, Filipa; ... Puthucheary, Zudin A; + view all <#> McNelly, Angela; Langan, Anne; Bear, Danielle E; Page, Alexandria; Martin, Tim; Seidu, Fatima; Santos, Filipa; Rooney, Kieron; Liang, Kaifeng; Heales, Simon J; Baldwin, Tomas; Alldritt, Isabelle; Crossland, Hannah; Atherton, Philip J; Wilkinson, Daniel; Montgomery, Hugh; Prowle, John; Pearse, Rupert; Eaton, Simon; Puthucheary, Zudin A; - view fewer <#> (2023) A pilot study of alternative substrates in the critically Ill subject using a ketogenic feed. Nature Communications , 14 (1) , Article 8345. 10.1038/s41467-023-42659-8 <https://doi.org/10.1038/s41467-023-42659-8>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10184236/1/s41467-023-42659-8.pdf