High protein hypocaloric versus normocaloric enteral nutrition in critically ill patients: A randomized clinical trial

Rugeles, R et al. Journal of Critical Care. Published online: 14 May 2016

Purpose: Appropriate caloric intake in critically ill patients receiving enteral nutrition is controversial. This study evaluates different caloric regimens on severity of organ failure measured with Sequential Organ Failure Assessment (SOFA).

Materials and methods: We conducted a randomized prospective controlled trial. Study population included adult ICU patients expected to require enteral nutrition for >96 hours. Goals in the intervention group were hypocaloric (15 kcal/kg/day) enteral nutrition of compared to normocaloric (25 kcal/kg/day) enteral nutrition, both with hyperproteic intake (1.7 g of protein/kg/day). Primary endpoint was change in SOFA score (ΔSOFA) from baseline at 48 hours. Secondary endpoints were: ΔSOFA at 96 hours, insulin requirements, hyperglycemia or hypoglycemic episodes, length of ICU stay, days on ventilator, and 28-days mortality.

Results: After screening 443 patients, 120 patients were analyzed. There were no differences between groups in baseline characteristics. We did not find a statistically significant difference in ΔSOFA at 48 hours. Patients in the hypocaloric group showed lower average daily insulin requirements and percentage of patients requiring any insulin.

Conclusions: Hyperproteic, hypocaloric nutrition did not show different outcomes compared to normocaloric nutrition, excepting lower insulin requirements. Hypocaloric nutrition could provide a more physiologic approach with lower need for care and metabolic impact.

Read the abstract here

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