Targeted Full Energy and Protein Delivery in Critically Ill Patients: A Pilot Randomized Controlled Trial (FEED Trial)

Fetterplace, Kate; Deane, Adam M.; Tierney, Audrey C.; Beach, Lisa; Knight, Laura D.; Presneill, Jeffrey; Rechnitzer, Thomas; Forsyth, Adrienne; Gill, Benjamin M T; Mourtzakis, Marina; MacIsaac, Christopher

doi:10.1002/jpen.1166

Cited by 105 publications

(129 citation statements)

References 45 publications

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“…Six trials were eligible for inclusion, which included 511 patients ( Figure 1, PRISMA diagram). [27][28][29][30][31][32]…”

Section: Resultsmentioning

confidence: 99%

“…The included trials were conducted over a range of years and in various regions (3 from Europe and 1 each from the United States of America, South America, and Australia) from 1993 to 2018. [27][28][29][30][31][32] The study objectives and interventions varied; however, all studies except that of Eyer et al 29 aimed to deliver protein within the guidelines' range from the outset in the intervention group and below the guidelines' range in the comparator group. In order to meet the higher protein requirements, all studies incorporated the use of a higher-protein enteral formula, with 2 studies also using supplemental protein powder.…”

Section: Study and Patient Characteristicsmentioning

confidence: 99%

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Systematic Review With Meta‐Analysis of Patient‐Centered Outcomes, Comparing International Guideline–Recommended Enteral Protein Delivery With Usual Care

Fetterplace

Gill

Chapple

et al. 2019

J Parenter Enteral Nutr

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Background: International guidelines recommend that protein be administered enterally to critically ill patients at doses between 1.2 and 2 g/kg per day Observational data indicate that patients frequently receive less protein. The aim of this systematic review was to evaluate patient-centered outcomes with guideline-recommended enteral protein compared with usual care. Methods: A systematic review was performed of randomized controlled trials including critically ill adult patients provided predominately enteral nutrition with mean protein at ࣙ1.2 g/kg per day (intervention) and <1.2 g/kg per day (comparator). Random-effects models were applied for outcomes reported in ࣙ3 trials. Results: Of 1375 abstracts, 69 full-text articles were reviewed, and 6 trials meet the inclusion criteria, including 511 patients. The intervention group received a mean (SD) of 1.3 (0.08) g/kg per day, and the comparator group received 0.75 (0.15) g/kg per day protein. Insufficient data were available for meta-analyses on the primary outcome (muscle mass or strength). According to our meta-analyses, mortality at 28 days (5 studies) (risk ratio 0.92 [95% Cl 0.63-1.35], P = .66) and the durations of intensive care unit (6 studies) and hospital admission (4 studies) were similar between the intervention and comparator, with some uncertainty due to sample sizes and heterogeneity. Conclusion: There are insufficient data to conclude whether protein provision within the current international guideline recommendations improves outcomes. In a limited dataset, enteral protein intakes near the lower level of current recommendations do not appear to reduce admission duration or mortality when compared with usual care in critically ill.

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“…Six trials were eligible for inclusion, which included 511 patients ( Figure 1, PRISMA diagram). [27][28][29][30][31][32]…”

Section: Resultsmentioning

confidence: 99%

Section: Study and Patient Characteristicsmentioning

confidence: 99%

Systematic Review With Meta‐Analysis of Patient‐Centered Outcomes, Comparing International Guideline–Recommended Enteral Protein Delivery With Usual Care

Fetterplace

Gill

Chapple

et al. 2019

J Parenter Enteral Nutr

Self Cite

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show abstract

“…Conversely, higher protein delivery during ICU admission has led to increased urea production and has been associated with increased muscle wasting in a small observational study [10,11,31,37]. In RCTs aiming to compare high versus lower protein delivery in critical illness, no benefit has been shown with an increased protein dose, although most have been underpowered to demonstrate an effect on clinical outcomes [11,[37][38][39]. The largest RCT (n = 474) investigating intravenous protein provided at a dose of up to 100 g/day compared to standard care found no impact on the primary outcome of renal dysfunction [37].…”

Section: Protein Delivery and Clinical Outcomesmentioning

confidence: 99%

Nutrition therapy in critical illness: a review of the literature for clinicians

et al. 2020

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Nutrition therapy during critical illness has been a focus of recent research, with a rapid increase in publications accompanied by two updated international clinical guidelines. However, the translation of evidence into practice is challenging due to the continually evolving, often conflicting trial findings and guideline recommendations. This narrative review aims to provide a comprehensive synthesis and interpretation of the adult critical care nutrition literature, with a particular focus on continuing practice gaps and areas with new data, to assist clinicians in making practical, yet evidence-based decisions regarding nutrition management during the different stages of critical illness.

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“…Several recent trials have incorporated measures of muscle mass or physical or functional outcomes into their study design, albeit mainly as secondary outcomes or in smaller sub-studies, with varying results [10][11][12]. As an example, EAT-ICU [11] [15] and stratification by post-critical illness biology [16] as methods to refine data for outcome analyses.…”

Section: Signal-to-noise Ratiosmentioning

confidence: 99%

Emerging outcome measures for nutrition trials in the critically ill

Bear¹,

Griffith

Puthucheary

2018

Current Opinion in Clinical Nutrition &Amp; Metabolic Care

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Targeted Full Energy and Protein Delivery in Critically Ill Patients: A Pilot Randomized Controlled Trial (FEED Trial)

Abstract: A high-protein volume-based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge.

Cited by 105 publications

References 45 publications

Systematic Review With Meta‐Analysis of Patient‐Centered Outcomes, Comparing International Guideline–Recommended Enteral Protein Delivery With Usual Care

Systematic Review With Meta‐Analysis of Patient‐Centered Outcomes, Comparing International Guideline–Recommended Enteral Protein Delivery With Usual Care

Nutrition therapy in critical illness: a review of the literature for clinicians

Emerging outcome measures for nutrition trials in the critically ill

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