TY - JOUR
T1 - Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit
T2 - A randomized controlled trial
AU - Charles, Eric J.
AU - Petroze, Robin T.
AU - Metzger, Rosemarie
AU - Hranjec, Tjasa
AU - Rosenberger, Laura H.
AU - Riccio, Lin M.
AU - McLeod, Matthew D.
AU - Guidry, Christopher A.
AU - Stukenborg, George J.
AU - Swenson, Brian R.
AU - Willcutts, Kate F.
AU - O'Donnell, Kelly B.
AU - Sawyer, Robert G.
N1 - Publisher Copyright:
© 2014 American Society for Nutrition.
PY - 2014/11/1
Y1 - 2014/11/1
N2 - 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.
AB - 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.
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U2 - 10.3945/ajcn.114.088609
DO - 10.3945/ajcn.114.088609
M3 - Article
C2 - 25332331
AN - SCOPUS:84908149075
SN - 0002-9165
VL - 100
SP - 1337
EP - 1343
JO - American Journal of Clinical Nutrition
JF - American Journal of Clinical Nutrition
IS - 5
ER -