Use of a concentrated enteral nutrition solution to increase calorie delivery to critically ill patients: a randomized, double-blind, clinical trial123

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ABSTRACT

Background:

Critically ill patients typically receive ∼60% of estimated calorie requirements.

Objectives:

We 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.

Design:

A 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.

Results:

The 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].

Conclusions:

The 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. This trial was registered at Australian New Zealand Clinical Trials (http://www.anzctr.org.au/) as ACTRN 12611000793910.

Cited by (0)

1

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).

2

Supported by the Royal Adelaide Hospital and the Australian and New Zealand College of Anaesthetists. Provision and blinding of the study feed and importation and delivery to the sites was provided by Fresenius Kabi (Germany).

3

Address correspondence to MJ Chapman, Intensive Care Unit, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. E-mail: [email protected].