Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial

Charles, Eric J.; Petroze, Robin T.; Metzger, Rosemarie; Hranjec, Tjasa; Rosenberger, Laura H.; Riccio, Lin M.; McLeod, Matthew D.; Guidry, Christopher A.; Stukenborg, George J.; Swenson, Brian R.; Willcutts, Kate; O’Donnell, Kelly; Sawyer, Robert G.

doi:10.3945/ajcn.114.088609

Cited by 96 publications

(136 citation statements)

References 31 publications

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“…The results of the 11 clinical trials in intensive care unit (ICU) patients that have investigated the impact of nutrition support on clinical outcomes within the past 5 y have varied (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The groups randomly assigned to higher energy intake had improved outcomes in 2 trials (8,9), no difference in 5 (1,(5)(6)(7)10), and worse outcomes in 4 (2-4, 11) than those randomly assigned to a lower intake. The 2 trials that found fewer infections with greater energy intake had problems with unintended imbalanced randomization that led to considerably greater numbers of patients prone to infection in the hypocaloric group (9) or issues regarding outcome reporting (8) that have raised questions about how these results should be interpreted (12).…”

Section: Introductionmentioning

confidence: 99%

“…Despite this long duration, large randomized clinical trials designed to detect the influence of providing enteral nutrition (EN) 8 and/or parenteral nutrition (PN) in this population have been conducted in the past 7 y. The results of the 11 clinical trials in intensive care unit (ICU) patients that have investigated the impact of nutrition support on clinical outcomes within the past 5 y have varied (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). The groups randomly assigned to higher energy intake had improved outcomes in 2 trials (8,9), no difference in 5 (1,(5)(6)(7)10), and worse outcomes in 4 (2-4, 11) than those randomly assigned to a lower intake.…”

Section: Introductionmentioning

confidence: 99%

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Role of timing and dose of energy received in patients with acute lung injury on mortality in the Intensive Nutrition in Acute Lung Injury Trial (INTACT): a post hoc analysis ,

Braunschweig

Freels

Sheean

et al. 2017

The American Journal of Clinical Nutrition

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Background: Our trial INTACT (Intensive Nutrition in Acute Lung Injury Trial) was designed to compare the impact of feeding from acute lung injury (ALI) diagnosis to hospital discharge, an interval that, to our knowledge, has not yet been explored. It was stopped early because participants who were randomly assigned to energy intakes at nationally recommended amounts via intensive medical nutrition therapy experienced significantly higher mortality hazards than did those assigned to standard nutrition support care that provided energy at 55% of recommended concentrations. Objective: We assessed the influence of dose and timing of feeding on hospital mortality. Design: Participants (n = 78) were dichotomized as died or discharged alive. Associations between the energy and protein received overall, early (days 1-7), and late (days $8) and the hazards of hospital mortality were evaluated between groups with multivariable analysis methods. Results: Higher overall energy intake predicted significantly higher mortality (OR: 1.14, 95% CI: 1.02, 1.27). Among participants enrolled for $8 d (n = 66), higher early energy intake significantly increased the HR for mortality (HR: 1.17, 95% CI: 1.07, 1.28), whereas higher late energy intake was significantly protective (HR: 0.91, 95% CI: 0.83, 1.0). Results were similar for early but not late protein (grams per kilogram) exposure (early-exposure HR: 8.9, 95% CI: 2.3, 34.3; late-exposure HR: 0.15, 95% CI: 0.02, 1.1). Threshold analyses indicated early mean intakes $18 kcal/kg significantly increased subsequent mortality. Conclusions: Providing kilocalories per kilogram or grams of protein per kilogram early post-ALI diagnosis at recommended levels was associated with significantly higher hazards for mortality, whereas higher late energy intakes reduced mortality hazards. This timevarying effect violated the Cox proportionality assumption, indicating that feeding trials in similar populations should extend beyond 7 d and use time-varying statistical methods. Future trials are required for corroboration. INTACT was registered at clinicaltrials.gov as NCT01921101.Am J Clin Nutr 2017;105:411-6.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Role of timing and dose of energy received in patients with acute lung injury on mortality in the Intensive Nutrition in Acute Lung Injury Trial (INTACT): a post hoc analysis ,

Braunschweig

Freels

Sheean

et al. 2017

The American Journal of Clinical Nutrition

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“…One study found more nosocomial infections in the underfeeding group while there was no significant effect on ICU and hospital mortality and duration of MV (45). Another found no differences regarding infections, ICU and hospital LOS and mortality (47). The last study found no differences in length of MV, hospital or ICU stay and infection but was prematurely interrupted at the first interim analysis with the observation of a statistically significant increase in mortality in the full-feeding group.…”

Section: Discussionmentioning

confidence: 89%

“…Recently, three RCTs compared underfeeding with full-feeding nutritional support in critically ill patients (45)(46)(47). They were excluded from our analysis due to the use of supplementary parenteral nutrition.…”

Section: Discussionmentioning

confidence: 99%

Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials

Franzosi¹,

Frankenberg²,

Loss³

et al. 2017

Nutr Hosp

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Franzosi OS, Von Frankenberg AD, Loss SH, Nunes DSL, Vieira SR. Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials. Resumen Introducción: a pesar de las directrices que hacen hincapié en que la cantidad de la Nutrición Enteral (NE) administrada debe estar próxima a las necesidades del paciente, los estudios prospectivos cuestionan esta estrategia.Objetivo: comparar el efecto de dos estrategias de NE (subalimentación vs. alimentación completa) sobre la mortalidad en la UCI y general (mortalidad hospitalaria o la mortalidad en 60 días), el tiempo de internación en la UCI y en el hospital, duración de la ventilación mecánica (VM), complicaciones infecciosas y la tolerancia gastrointestinal en pacientes críticos.Métodos: metaanálisis de efectos aleatorios de ensayos clínicos aleatorizados (ECA). Nuestra búsqueda se basa en MEDLINE, EMBASE, SCOPUS y CENTRAL hasta mayo de 2015. La subalimentación fue asignada a dos grupos diferentes de acuerdo con el nivel de consumo de energía (alimentación moderada 46-72% y la alimentación trófi ca 16-25%) para el análisis de subgrupos.Resultados: se incluyeron cinco ECA entre los 904 estudios que se encontraron en la búsqueda (n = 2.432 pacientes). No se encontraron diferencias en la mortalidad general cuando se combinaron los cinco estudios. En el análisis de subgrupos, la alimentación moderada (tres estudios) mostró una mortalidad más baja en comparación con la alimentación completa (RR 0,82; IC 95% 0,68-0,98; I 2 0% p = 0,59 para la heterogeneidad). No se encontraron diferencias de mortalidad en la UCI ni en el tiempo de internación hospitalaria, la duración de la VM y las complicaciones infecciosas. La subalimentación mostró menor aparición de signos y síntomas gastrointestinales, excepto para aspiración y distensión abdominal (no se encontró ninguna diferencia).Conclusiones: este metaanálisis no encontró diferencias signifi cativas de mortalidad, duración de la estancia, duración de VM ni complicaciones infecciosas en la UCI o hospitalización total entre los grupos de subalimentación y alimentación completa. El análisis de subgrupos mostró menor mortalidad global entre los pacientes que recibieron la subalimentación moderada. Este resultado debe interpretarse con cautela debido a las limitaciones del pequeño número de estudios analizados y su metodología. Key words:Enteral nutrition. Critical care. Mortality. Artifi cial respiration. Digestive signs and symptoms. AbstractIntroduction: Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient's needs, prospective studies question this strategy.

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“…Diversas pesquisas científicas apontam que a evolução clínica dos pacientes internados depende da adequada ingestão de água, energia e nutrientes (20)(21)(22)(23)(24)(25)(26)(27)(28)(29) .…”

Section: O Cuidado Alimentar E Nutricional No Ambiente Hospitalarunclassified

Carga de trabalho do nutricionista clínico: estudo de tempo e movimento contínuo em unidades de internação hospitalar

Oliveira¹

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Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial

Abstract: Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.

Cited by 96 publications

References 31 publications

Role of timing and dose of energy received in patients with acute lung injury on mortality in the Intensive Nutrition in Acute Lung Injury Trial (INTACT): a post hoc analysis ,

Role of timing and dose of energy received in patients with acute lung injury on mortality in the Intensive Nutrition in Acute Lung Injury Trial (INTACT): a post hoc analysis ,

Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials

Carga de trabalho do nutricionista clínico: estudo de tempo e movimento contínuo em unidades de internação hospitalar

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