Optimized calorie and high protein intake versus recommended caloric-protein intake in critically ill patients: a prospective, randomized, controlled phase II clinical trial

Abstract

Objective To evaluate differences in outcomes for an optimized calorie and high protein nutrition therapy versus standard nutrition care in critically ill adult patients. Methods We randomized patients expected to stay in the intensive care unit for at least 3 days. In the optimized calorie and high protein nutrition group, caloric intake was determined by indirect calorimetry, and protein intake was established at 2.0 to 2.2g/kg/day. The control group received 25kcal/kg/day of calories and 1.4 to 1.5g/kg/day protein. The primary outcome was the physical component summary score obtained at 3 and 6 months. Secondary outcomes included handgrip strength at intensive care unit discharge, duration of mechanical ventilation and hospital mortality. Results In total, 120 patients were included in the analysis. There was no significant difference between the two groups in calories received. However, the amount of protein received by the optimized calorie and high protein nutrition group was significantly higher compared with the control group. The physical component summary score at 3 and 6 months did not differ between the two groups nor did secondary outcomes. However, after adjusting for covariates, a negative delta protein (protein received minus predetermined protein requirement) was associated with a lower physical component summary score at 3 and 6 months postrandomization. Conclusion In this study optimized calorie and high protein strategy did not appear to improve physical quality of life compared with standard nutrition care. However, after adjusting for covariates, a negative delta protein was associated with a lower physical component summary score at 3 and 6 months postrandomization. This association exists independently of the method of calculation of protein target.

Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis

“…These studies were published from 2011 to 2020. Seven out of the eight trials were single-center studies [ 7 , 12 , 15 , 20 – 23 ]. All the eight RCTs recruited ventilated patients (sample size ranges from 40 to 417 cases), with 489 in the IC group and 484 in the control group, respectively.…”

“…However, the authors reviewed only four trials with a total of 398 patients [ 7 , 20 – 22 ]. By contrast, our meta-analysis had a larger sample size than the previous meta-analysis as it added four other trials published recently [ 12 – 15 , 23 ], with more power to assess this effect. In the 2018 ESPEN guideline on ICU nutrition [ 10 ], Singer et al performed a meta-analysis of RCTs that focused only on using IC as a calorie target and found a trend ( P = 0.07) to improve the short-term mortality.…”

“…Recently, several studies on this topic have been published [ 12 – 15 ], and some of these studies have a modest sample size, while the conclusions are inconsistent. Therefore, with the aid of increased power of meta-analytic techniques, we sought to investigate whether IC-guided energy delivery strategy in critically ill patients may be more effective in reducing short-term mortality and other clinical outcomes than PEE predictive equations.…”

Energy Delivery Guided by Indirect Calorimetry in Critically Ill Patients: a Systematic Review and Meta-analysis

“…However, the authors reviewed only four trials with a total of 398 patients [7,[20][21][22]. By contrast, our meta-analysis had a larger sample size than the previous meta-analysis as it added four other trials published recently [12][13][14][15]23], with more power to assess this effect. In the 2018 ESPEN guideline on ICU nutrition [10], Singer et al performed a meta-analysis of RCTs that focused only on using IC as a calorie target and found a trend (P = 0.07) to improve the short-term mortality.…”

Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis

“…Recently, several studies on this topic have been published [12][13][14][15], and some of these studies have a modest sample size, while the conclusions are inconsistent. Therefore, with the aid of increased power of meta-analytic techniques, we sought to investigate whether IC-guided energy delivery strategy in critically ill patients may be more effective in reducing short-term mortality and other clinical outcomes than PEE predictive equations.…”