BACKGROUND: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. OBJECTIVE: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. DESIGN:Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg(-1) · d(-1) (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg(-1) · d(-1)). RESULTS: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (± SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. CONCLUSIONS: 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.
RCT Entities:
BACKGROUND: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. OBJECTIVE: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. DESIGN: Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg(-1) · d(-1) (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg(-1) · d(-1)). RESULTS: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (± SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. CONCLUSIONS: 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.
Authors: Stephen A McClave; Robert G Martindale; Vincent W Vanek; Mary McCarthy; Pamela Roberts; Beth Taylor; Juan B Ochoa; Lena Napolitano; Gail Cresci Journal: JPEN J Parenter Enteral Nutr Date: 2009 May-Jun Impact factor: 4.016
Authors: Robert G Martindale; Stephen A McClave; Vincent W Vanek; Mary McCarthy; Pamela Roberts; Beth Taylor; Juan B Ochoa; Lena Napolitano; Gail Cresci Journal: Crit Care Med Date: 2009-05 Impact factor: 7.598
Authors: Yaseen M Arabi; Hani M Tamim; Gousia S Dhar; Abdulaziz Al-Dawood; Muhammad Al-Sultan; Maram H Sakkijha; Salim H Kahoul; Riette Brits Journal: Am J Clin Nutr Date: 2011-01-26 Impact factor: 7.045
Authors: M L Borum; J Lynn; Z Zhong; K Roth; A F Connors; N A Desbiens; R S Phillips; N V Dawson Journal: J Am Geriatr Soc Date: 2000-05 Impact factor: 5.562
Authors: Todd W Rice; Susan Mogan; Margaret A Hays; Gordon R Bernard; Gordon L Jensen; Arthur P Wheeler Journal: Crit Care Med Date: 2011-05 Impact factor: 7.598
Authors: Simon Vanderheyden; Michael P Casaer; Katrien Kesteloot; Steven Simoens; Thomas De Rijdt; Guido Peers; Pieter J Wouters; Jocelijn Coenegrachts; Tine Grieten; Katleen Polders; Ann Maes; Alexander Wilmer; Jasperina Dubois; Greet Van den Berghe; Dieter Mesotten Journal: Crit Care Date: 2012-05-25 Impact factor: 9.097
Authors: Dale M Needham; Victor D Dinglas; O Joseph Bienvenu; Elizabeth Colantuoni; Amy W Wozniak; Todd W Rice; Ramona O Hopkins Journal: BMJ Date: 2013-03-19
Authors: Andrew Rhodes; Laura E Evans; Waleed Alhazzani; Mitchell M Levy; Massimo Antonelli; Ricard Ferrer; Anand Kumar; Jonathan E Sevransky; Charles L Sprung; Mark E Nunnally; Bram Rochwerg; Gordon D Rubenfeld; Derek C Angus; Djillali Annane; Richard J Beale; Geoffrey J Bellinghan; Gordon R Bernard; Jean-Daniel Chiche; Craig Coopersmith; Daniel P De Backer; Craig J French; Seitaro Fujishima; Herwig Gerlach; Jorge Luis Hidalgo; Steven M Hollenberg; Alan E Jones; Dilip R Karnad; Ruth M Kleinpell; Younsuk Koh; Thiago Costa Lisboa; Flavia R Machado; John J Marini; John C Marshall; John E Mazuski; Lauralyn A McIntyre; Anthony S McLean; Sangeeta Mehta; Rui P Moreno; John Myburgh; Paolo Navalesi; Osamu Nishida; Tiffany M Osborn; Anders Perner; Colleen M Plunkett; Marco Ranieri; Christa A Schorr; Maureen A Seckel; Christopher W Seymour; Lisa Shieh; Khalid A Shukri; Steven Q Simpson; Mervyn Singer; B Taylor Thompson; Sean R Townsend; Thomas Van der Poll; Jean-Louis Vincent; W Joost Wiersinga; Janice L Zimmerman; R Phillip Dellinger Journal: Intensive Care Med Date: 2017-01-18 Impact factor: 17.440
Authors: Mario I Perman; Agustín Ciapponi; Juan Va Franco; Cecilia Loudet; Adriana Crivelli; Virginia Garrote; Gastón Perman Journal: Cochrane Database Syst Rev Date: 2018-06-04