TICACOS international: A multi-center, randomized, prospective controlled study comparing tight calorie control versus Liberal calorie administration study

Singer, Pierre; Waele, Elisabeth De; Navarro, Carmen; Santana, S. Ruiz; Montejo, Juan Carlos; Laterre, Pierre‐François; Soroksky, Arie; Moscovici, E; Kagan, Ilya

doi:10.1016/j.clnu.2020.05.024

Cited by 37 publications

(68 citation statements)

References 30 publications

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“…Several clinical investigations have shown that hypocaloric feeding or permissive underfeeding could shorten duration of ventilator dependency and lead to decreased hospital mortality in critically ill patients [ 10 , 11 , 12 , 13 , 14 ]. Higher energy intake not only failed to show better clinical outcomes but generated poor consequences in some studies [ 15 , 16 , 17 ]. In addition, no mortality differences were observed among patients receiving permissive underfeeding, trophic feeding, full caloric feeding, and energy-dense feeding [ 15 , 18 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Full versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial

Wang

Chao

et al. 2020

Nutrients

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Although energy intake might be associated with clinical outcomes in critically ill patients, it remains unclear whether full or trophic feeding is suitable for critically ill patients with high or low nutrition risk. We conducted a prospective study to determine which feeding energy intakes were associated with clinical outcomes in critically ill patients with high or low nutrition risk. This was an investigator-initiated, single center, single blind, randomized controlled trial. Critically ill patients were allocated to either high or low nutrition risk based on their Nutrition Risk in the Critically Ill score, and then randomized to receive either the full or the trophic feeding. The feeding procedure was administered for six days. No significant differences were observed in hospital, 14-day and 28-day mortalities, the length of ventilator dependency, or ICU and hospital stay among the four groups. There were no associations between energy and protein intakes and hospital, 14-day and 28-day mortalities in any of the four groups. However, protein intake was positively associated with the length of hospital stay and ventilator dependency in patients with low nutrition risk receiving trophic feeding. Full or trophic feeding in critically ill patients showed no associations with clinical outcomes, regardless of nutrition risk.

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Section: Introductionmentioning

confidence: 99%

Full versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial

Wang

Chao

et al. 2020

Nutrients

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“…Moreover, the IC group received a calorie intake (89-106%) closer to the measured target than the control group (56-79%) [7,14,20,21]. Mean protein delivered/day was reported in four trials [7,14,20,21], and pooled the results showed a signi cantly higher protein delivered in the IC group when compared with the control group (MD = 20 g/day; 95% CI 16 to 25; I 2 = 4%; P < 0.00001).…”

Section: Trial Identi Cation and Characteristicsmentioning

confidence: 89%

“…Our literature search yielded 964 potentially eligible articles through database searching. Further screening of 14 full texts identi ed 8 RCTs with 911 patients that ful lled our inclusion criteria and were included in the nal analysis [7,[13][14][15][20][21][22][23]. Figure 1 shows the owchart of the search strategy and the reasons for exclusion.…”

Section: Trial Identi Cation and Characteristicsmentioning

confidence: 99%

“…In the IC group, a signi cant day to day variation was observed in energy targets assessed by IC. Mean energy delivered/day was described in four trials [7,[13][14][15][20][21][22], and pooled the results showed signi cantly higher energy delivered in the IC group than the control group (MD = 622 kcal/day; 95% CI 407 to 837; I 2 = 85%; P < 0.00001). Moreover, the IC group received a calorie intake (89-106%) closer to the measured target than the control group (56-79%) [7,14,20,21].…”

Section: Trial Identi Cation and Characteristicsmentioning

confidence: 99%

“…Mean energy delivered/day was described in four trials [7,[13][14][15][20][21][22], and pooled the results showed signi cantly higher energy delivered in the IC group than the control group (MD = 622 kcal/day; 95% CI 407 to 837; I 2 = 85%; P < 0.00001). Moreover, the IC group received a calorie intake (89-106%) closer to the measured target than the control group (56-79%) [7,14,20,21]. Mean protein delivered/day was reported in four trials [7,14,20,21], and pooled the results showed a signi cantly higher protein delivered in the IC group when compared with the control group (MD = 20 g/day; 95% CI 16 to 25; I 2 = 4%; P < 0.00001).…”

Section: Trial Identi Cation and Characteristicsmentioning

confidence: 99%

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

Duan

Zheng

Zhou

et al. 2020

Preprint

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Background: The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population.Methods: We searched PubMed, EMBASE, and Cochrane library databases up to Oct 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results: Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio=0.77; 95% CI, 0.60 to 0.98; I2=3%, P=0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD]=0.61 days; 95% CI, -1.08 to 2.29; P=0.48), length of stay in ICU (MD=0.32 days; 95% CI, -2.51 to 3.16; P=0.82) and hospital (MD=0.30 days; 95% CI, -3.23 to 3.83; P=0.87). Additionally, adverse events were similar between the two groups. Conclusions: This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.

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Point‐Counterpoint: Indirect Calorimetry Is not Necessary for Optimal Nutrition Therapy in Critical Illness

McClave

Omer

2021

Nut in Clin Prac

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Clinicians have widely recognized that indirect calorimetry (IC) is the "gold standard" for measuring energy expenditure (EE) and thus would intuitively anticipate that its use would be needed to provide optimal nutrition support in critical illness. Recent studies in the literature as well as dramatic changes in clinical practice over the past decade, though, would suggest that such a precise measure by IC to set energy goals is not required to maximize clinical benefit from early feeding in the intensive care unit (ICU). Results from randomized controlled trials evaluating permissive underfeeding, use of supplemental parenteral nutrition to achieve tight calorie control, and caloric density of formulas to increase energy delivery have provided an important perspective on 3 pertinent issues.First, a simple weight-based predictive equation (25 kcal/kg/day) provides a clinically useful approximation of EE. Second, a precise measure of EE by IC does not appear to improve outcomes compared with use of this less accurate estimation of energy requirements. And third, providing some percentage of requirements (50%-80%), achieves similar clinical benefit to full feeding (100%) in the early phases of critical illness. The value from IC use lies in the determination of caloric requirements in conditions for which weight-based equations are rendered inaccurate (anasarca, amputation, severe obesity) or the clinical state is markedly altered (such as the prolonged hyperinflammatory state of coronavirus disease 2019 ). In most other circumstances, routine use of IC would not be expected to change clinical outcomes from early nutrition therapy in the ICU.

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TICACOS international: A multi-center, randomized, prospective controlled study comparing tight calorie control versus Liberal calorie administration study

Cited by 37 publications

References 30 publications

Full versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial

Full versus Trophic Feeds in Critically Ill Adults with High and Low Nutritional Risk Scores: A Randomized Controlled Trial

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

Point‐Counterpoint: Indirect Calorimetry Is not Necessary for Optimal Nutrition Therapy in Critical Illness

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