Early Goal-directed Nutrition Versus Standard of Care in Adult Intensive Care Patients: the Single-centre, Randomised, Outcome Assessor-blinded EAT-ICU Trial

Overview

Journal Intensive Care Med

Specialty Critical Care

Date 2017 Sep 23

PMID 28936712

Citations 98

Authors

Matilde Jo Allingstrup

Jens Kondrup

Jorgen Wiis

Casper Claudius

Ulf Gottrup Pedersen

Rikke Hein-Rasmussen

Mads Rye Bjerregaard

Morten Steensen

Tom Hartvig Jensen

Theis Lange

Martin Bruun Madsen

Morten Hylander Moller

Anders Perner

Affiliations

Soon will be listed here.

Abstract

Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients.

Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders.

Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline variables were reasonably balanced between the two groups. The EGDN group had less negative energy (p < 0.001) and protein (p < 0.001) balances in the ICU as compared to the standard of care group. The PCS score at 6 months did not differ between the two groups (mean difference 0.0, 95% CI -5.9 to 5.8, p = 0.99); neither did mortality, rates of organ failures, serious adverse reactions or infections in the ICU, length of ICU or hospital stay, or days alive without life support at 90 days.

Conclusions: EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients. Clinicaltrials.gov identifier no. NCT01372176.

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