Abstract
Although energy intake might be associated with clinical outcomes in critically ill patients, it remains unclear whether full or trophic feeding is suitable for critically ill patients with high or low nutrition risk. We conducted a prospective study to determine which feeding energy intakes were associated with clinical outcomes in critically ill patients with high or low nutrition risk. This was an investigator-initiated, single center, single blind, randomized controlled trial. Critically ill patients were allocated to either high or low nutrition risk based on their Nutrition Risk in the Critically Ill score, and then randomized to receive either the full or the trophic feeding. The feeding procedure was administered for six days. No significant differences were observed in hospital, 14-day and 28-day mortalities, the length of ventilator dependency, or ICU and hospital stay among the four groups. There were no associations between energy and protein intakes and hospital, 14-day and 28-day mortalities in any of the four groups. However, protein intake was positively associated with the length of hospital stay and ventilator dependency in patients with low nutrition risk receiving trophic feeding. Full or trophic feeding in critically ill patients showed no associations with clinical outcomes, regardless of nutrition risk.
Highlights
Optimal energy delivery for patients in the intensive care unit (ICU) remains a challenge
The European Society for Clinical Nutrition and Metabolism (ESPEN) guideline recommends less than 70% of predicted energy intake for critically ill patients in the acute phase [9]
Supplemental parenteral nutrition is recommended when enteral nutrition is insufficient, especially when a patient’s NRS 2002 score is ≥3 or Nutrition Risk in the Critically Ill (NUTRIC) score is ≥5 [22]
Summary
Optimal energy delivery for patients in the intensive care unit (ICU) remains a challenge. Studies have shown that insufficient energy delivery is associated with increased nosocomial infection, prolonged hospital stay, and prolonged ventilator dependency [1,2,3,4]. If energy delivery could reach at least 80% of predicted calories, clinical outcomes might be improved [5,6,7].in a large database study, it was revealed that 30–70% of predicted energy intake generated the lowest 30-day mortality [8]. Nutrients 2020, 12, 3518 investigations have shown that hypocaloric feeding or permissive underfeeding could shorten duration of ventilator dependency and lead to decreased hospital mortality in critically ill patients [10,11,12,13,14]. No mortality differences were observed among patients receiving permissive underfeeding, trophic feeding, full caloric feeding, and energy-dense feeding [15,18,19]
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