Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial

Allingstrup, Mikkel; Kondrup, Jens; Wiis, Jørgen; Claudius, Casper; Pedersen, Ulf Gøttrup; Hein-Rasmussen, Rikke; Bjerregaard, Mads Rye; Steensen, Morten; Jensen, Thomas; Lange, Theis; Madsen, Martin Bruun; Møller, Morten Hylander; Perner, Anders

doi:10.1007/s00134-017-4880-3

Cited by 235 publications

(293 citation statements)

References 40 publications

Supporting

Mentioning

256

Contrasting

Unclassified

Order By: Relevance

“…As reported in multiple studies, we also found energy overfeeding to be associated with higher mortality in non‐sepsis patients . Furthermore, we did not find a survival benefit for early medium (80%–110%) energy intake compared with early low energy intake, in line with recent RCTs …”

Section: Discussionsupporting

confidence: 90%

See 1 more Smart Citation

Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non‐Septic ICU Patients on Prolonged Mechanical Ventilation: The PROCASEPT Retrospective Study

Koning

Koekkoek

Kars

et al. 2019

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Background The optimal nutritional support for critically ill septic patients remains unknown. This study evaluates the associations of macronutrient intake during the first week of intensive care unit (ICU) admission and long‐term clinical outcomes in septic and non‐septic patients. Methods Prolonged mechanically ventilated patients were retrospectively studied. The association of protein (low: <0.8 g/kg/d, medium: 0.8–1.2 g/kg/d, high >1.2 g/kg/d) and energy intake (<80%, 80%–110%, 110% of target) during days 1–3 and 4–7 after ICU admission and 6‐month mortality was analyzed for septic and non‐septic patients separately. Results A total of 423 patients were investigated. Of these, 297 had sepsis. In the sepsis group, medium protein intake at days 4–7 was associated with lower 6‐month mortality (hazard ratio [HR]: 0.646, 95% confidence interval [CI]: 0.418‐0.996, P=0.048) compared with high intake. In the non‐sepsis group, early high and late low protein intake were associated with higher 6‐month mortality (HR: 3.902, 95% CI: 1.505‐10.115, P=0.005; HR: 2.642, 95% CI: 1.128‐6.189, P=0.025) compared with low and high protein intake, respectively. For energy intake, late energy intake of >110% was associated with decreased mortality in septic patients (HR: 0.400, 95% CI: 0.222‐0.721, P=0.002), whereas in non‐septic patients, late medium energy intake (80%–110%) was associated with better survival (HR: 0.379, 95% CI: 0.175‐0.820, P=0.014), both compared with low energy intake. Conclusion Divergent associations of macronutrient intake were found; early high protein intake in non‐septic patients, but not in septic patients, was found to be associated with higher 6‐month mortality.

show abstract

Section: Discussionsupporting

confidence: 90%

“…For energy intake, recent RCTs do not report survival benefit of early provision of approximately 100% of energy expenditure compared with lower energy intakes . Furthermore, overfeeding (>110%) has been associated with increased morbidity and mortality .…”

Section: Introductionmentioning

confidence: 99%

Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non‐Septic ICU Patients on Prolonged Mechanical Ventilation: The PROCASEPT Retrospective Study

Koning

Koekkoek

Kars

et al. 2019

J Parenter Enteral Nutr

View full text Add to dashboard Cite

show abstract

“…Indeed, several experts have suggested that the feeding target should be determined by indirect calorimetry rather than by a formula . Nevertheless, 3 recent RCTs that used indirect calorimetry in the intervention group did not find any benefit of such strategy . Moreover, aggregating the results of these trials suggested that individualized nutrition, which led to an increased feeding dose, was ineffective …”

Section: Results From Recent Feeding Rctsmentioning

confidence: 99%

“…Similarly, in the PEPaNIC study, urea levels significantly increased by administering early PN, with an increased need for renal replacement therapy . Likewise, the Intravenous Amino Acid Therapy for Kidney Function in Critically Ill and (Nephro‐Protective) the Early Goal‐Directed Nutrition Versus Standard of Care in Adult Intensive Care Patients (EAT‐ICU) trials revealed increased ureagenesis by giving more amino acids …”

Section: Mechanisms Explaining Why Early Feeding Has Failed To Benefimentioning

confidence: 95%

Autophagy and Its Implications Against Early Full Nutrition Support in Critical Illness

2018

View full text Add to dashboard Cite

The timing, dose, and route of early nutrition support in critically ill patients have been highly controversial for years. Despite the association of a caloric deficit with adverse outcome, several recent large, randomized, controlled trials have demonstrated a prolongation of organ failure and increased muscle weakness with increasing doses of nutrition in the acute phase of critical illness. A potential explanation for the negative impact of early, full feeding on outcome is feeding-induced suppression of autophagy, a cellular repair process that is necessary to clear intracellular damage. Whether nutrition management in critically ill patients should be guided by its effects on autophagy is a topic of debate. Currently, however, autophagy cannot be monitored in clinical practice. Moreover, clinical management should be guided by high-quality randomized controlled trials, which currently do not support the use of early full nutrition support.

show abstract

“…This conclusion applies to the design and interpretation of prospective clinical trials. Two recent clinical outcome RCTs compared moderate protein and full calorie provision with permissive underfeeding; the results were disappointing . When clinical trial designs like these are used, the harmful effects of full energy provision (and its associated large fluid volumes) could well negate the benefits of more generous protein provision.…”

Section: Permissive Underfeeding and Clinical Outcomesmentioning

confidence: 99%

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Hoffer

2018

Nut in Clin Prac

View full text Add to dashboard Cite

High-protein hypocaloric nutrition, tailored to each patient's muscle mass, protein-catabolic severity, and exogenous energy tolerance, is the most plausible nutrition therapy in protein-catabolic critical illness. Sufficient protein provision could mitigate the rapid muscle atrophy characteristic of this disease while providing urgently needed amino acids to the central protein compartment and sites of tissue injury. The protein dose may range from 1.5 to 2.5 g protein (1.8-3.0 g free amino acids)/kg dry body weight per day. Nutrition should be low in energy (≈70% of energy expenditure or ≈15 kcal/kg dry body weight per day) because efforts to match energy provision to energy expenditure are physiologically irrational, risk toxic energy overfeeding, and have repeatedly failed in large clinical trials to demonstrate clinical benefit. The American Society for Parenteral and Enteral Nutrition currently suggests high-protein hypocaloric nutrition for obese critically ill patients. Short-term high-protein hypocaloric nutrition is physiologically and clinically sensible for most protein-catabolic critically ill patients, whether obese or not.

show abstract

Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial

Abstract: EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients. Clinicaltrials.gov identifier no. NCT01372176.

Cited by 235 publications

References 40 publications

Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non‐Septic ICU Patients on Prolonged Mechanical Ventilation: The PROCASEPT Retrospective Study

Association of PROtein and CAloric Intake and Clinical Outcomes in Adult SEPTic and Non‐Septic ICU Patients on Prolonged Mechanical Ventilation: The PROCASEPT Retrospective Study

Autophagy and Its Implications Against Early Full Nutrition Support in Critical Illness

High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Contact Info

Product

Resources

About