• Sandra L Peake, Andrew R Davies, Adam M Deane, Kylie Lange, John L Moran, Stephanie N O'Connor, Emma J Ridley, Patricia J Williams, Marianne J Chapman, and TARGET investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group.
• From the Queen Elizabeth Hospital (SLP, JLM, and PJW), the Royal Adelaide Hospital (AMD, SNO, and MJC), the Discipline of Acute Care Medicine, University of Adelaide, Adelaide, Australia; the Department of Epidemiology and Preventive Medicine, Australian and New Zealand Intensive Care Research Centre, Monash University, Victoria, Australia (ARD and EJR); and the Centre for Research Excellence in Translating Nutritional Science into Good Health, National Health and Medical Research Council, University of Adelaide, Adelaide, Australia (KL).
• Am. J. Clin. Nutr. 2014 Aug 1;100(2):616-25.

BackgroundCritically ill patients typically receive ∼60% of estimated calorie requirements.ObjectivesWe aimed to determine whether the substitution of a 1.5-kcal/mL enteral nutrition solution for a 1.0-kcal/mL solution resulted in greater calorie delivery to critically ill patients and establish the feasibility of conducting a multicenter, double-blind, randomized trial to evaluate the effect of an increased calorie delivery on clinical outcomes.DesignA prospective, randomized, double-blind, parallel-group, multicenter study was conducted in 5 Australian intensive care units. One hundred twelve mechanically ventilated patients expected to receive enteral nutrition for ≥2 d were randomly assigned to receive 1.5 (n = 57) or 1.0 (n = 55) kcal/mL enteral nutrition solution at a rate of 1 mL/kg ideal body weight per hour for 10 d. Protein and fiber contents in the 2 solutions were equivalent.ResultsThe 2 groups had similar baseline characteristics (1.5 compared with 1.0 kcal/mL). The mean (±SD) age was 56.4 ± 16.8 compared with 56.5 ± 16.1 y, 74% compared with 75% were men, and the Acute Physiology and Chronic Health Evaluation II score was 23 ± 9.1 compared with 22 ± 8.9. The groups received similar volumes of enteral nutrition solution [1221 mL/d (95% CI: 1120, 1322 mL/d) compared with 1259 mL/d (95% CI: 1143, 1374 mL/d); P = 0.628], which led to a 46% increase in daily calories in the group given the 1.5-kcal/mL solution [1832 kcal/d (95% CI: 1681, 1984 kcal/d) compared with 1259 kcal/d (95% CI: 1143, 1374 kcal/d); P < 0.001]. The 1.5-kcal/mL solution was not associated with larger gastric residual volumes or diarrhea. In this feasibility study, there was a trend to a reduced 90-d mortality in patients given 1.5 kcal/mL [11 patients (20%) compared with 20 patients (37%); P = 0.057].ConclusionsThe substitution of a 1.0- with a 1.5-kcal/mL enteral nutrition solution administered at the same rate resulted in a 46% greater calorie delivery without adverse effects. The results support the conduct of a large-scale trial to evaluate the effect of increased calorie delivery on clinically important outcomes in the critically ill.© 2014 American Society for Nutrition.

26 keywords...

hide…