TY - JOUR
T1 - The tight calorie control study (TICACOS)
T2 - A prospective, randomized, controlled pilot study of nutritional support in critically ill patients
AU - Singer, Pierre
AU - Anbar, Ronit
AU - Cohen, Jonathan
AU - Shapiro, Haim
AU - Shalita-Chesner, Michal
AU - Lev, Shaul
AU - Grozovski, Elad
AU - Theilla, Miryam
AU - Frishman, Sigal
AU - Madar, Zecharia
PY - 2011/4
Y1 - 2011/4
N2 - Purpose: To determine whether nutritional support guided by repeated measurements of resting energy requirements improves the outcome of critically ill patients. Methods: This was a prospective, randomized, single-center, pilot clinical trial conducted in an adult general intensive care (ICU) unit. The study population comprised mechanically ventilated patients (n = 130) expected to stay in ICU more than 3 days. Patients were randomized to receive enteral nutrition (EN) with an energy target determined either (1) by repeated indirect calorimetry measurements (study group, n = 56), or (2) according to 25 kcal/kg/day (control group, n = 56). EN was supplemented with parenteral nutrition when required. Results: The primary outcome was hospital mortality. Measured pre-study resting energy expenditure (REE) was similar in both groups (1,976 ± 468 vs. 1,838 ± 468 kcal, p = 0.6). Patients in the study group had a higher mean energy (2,086 ± 460 vs. 1,480 ± 356 kcal/day, p = 0.01) and protein intake (76 ± 16 vs. 53 ± 16 g/day, p = 0.01). There was a trend towards an improved hospital mortality in the intention to treat group (21/65 patients, 32.3% vs. 31/65 patients, 47.7%, p = 0.058) whereas length of ventilation (16.1 ± 14.7 vs. 10.5 ± 8.3 days, p = 0.03) and ICU stay (17.2 ± 14.6 vs. 11.7 ± 8.4, p = 0.04) were increased. Conclusions: In this single-center pilot study a bundle comprising actively supervised nutritional intervention and providing near target energy requirements based on repeated energy measurements was achievable in a general ICU and may be associated with lower hospital mortality.
AB - Purpose: To determine whether nutritional support guided by repeated measurements of resting energy requirements improves the outcome of critically ill patients. Methods: This was a prospective, randomized, single-center, pilot clinical trial conducted in an adult general intensive care (ICU) unit. The study population comprised mechanically ventilated patients (n = 130) expected to stay in ICU more than 3 days. Patients were randomized to receive enteral nutrition (EN) with an energy target determined either (1) by repeated indirect calorimetry measurements (study group, n = 56), or (2) according to 25 kcal/kg/day (control group, n = 56). EN was supplemented with parenteral nutrition when required. Results: The primary outcome was hospital mortality. Measured pre-study resting energy expenditure (REE) was similar in both groups (1,976 ± 468 vs. 1,838 ± 468 kcal, p = 0.6). Patients in the study group had a higher mean energy (2,086 ± 460 vs. 1,480 ± 356 kcal/day, p = 0.01) and protein intake (76 ± 16 vs. 53 ± 16 g/day, p = 0.01). There was a trend towards an improved hospital mortality in the intention to treat group (21/65 patients, 32.3% vs. 31/65 patients, 47.7%, p = 0.058) whereas length of ventilation (16.1 ± 14.7 vs. 10.5 ± 8.3 days, p = 0.03) and ICU stay (17.2 ± 14.6 vs. 11.7 ± 8.4, p = 0.04) were increased. Conclusions: In this single-center pilot study a bundle comprising actively supervised nutritional intervention and providing near target energy requirements based on repeated energy measurements was achievable in a general ICU and may be associated with lower hospital mortality.
KW - Critically ill
KW - Energy balance
KW - Indirect calorimetry
KW - Nutritional support
UR - http://www.scopus.com/inward/record.url?scp=79953825136&partnerID=8YFLogxK
U2 - 10.1007/s00134-011-2146-z
DO - 10.1007/s00134-011-2146-z
M3 - Article
C2 - 21340655
AN - SCOPUS:79953825136
SN - 0342-4642
VL - 37
SP - 601
EP - 609
JO - Intensive Care Medicine
JF - Intensive Care Medicine
IS - 4
ER -