Use of a concentrated enteral nutrition solution to increase calorie delivery to critically ill patients: a randomized, double-blind, clinical trial.
What this study found
The concentrated 1.5 kcal/mL formula increased calorie delivery without increasing enteral intolerance. Daily calorie delivery was 1832 kcal/d versus 1259 kcal/d with the 1.0 kcal/mL formula (P < 0.001), and 89% versus 16% of study feeding days met estimated caloric requirements. Daily volume delivered was similar (1221 mL/d versus 1259 mL/d; P = 0.628), showing the benefit came from higher energy density rather than higher volume. Ninety-day mortality was 20% versus 37% (P = 0.057), but ICU, hospital, and 28-day mortality did not differ, and the trial was not powered to test mortality…
- Study & population
- Multicenter, randomized, double-blind trial in 5 Australian tertiary-referral ICUs.
- Intervention
- Critically ill adults received a concentrated enteral nutrition formula at 1.5 kcal/mL, delivered enterally at 1 mL/kg ideal body weight per hour, with a maximum rate of 100 mL/h.
- Key limitation
- The sample size was small and the study was not powered for mortality or other clinical outcomes.
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Open PDFOriginal abstract
BACKGROUND Critically ill patients typically receive ∼60% of estimated calorie requirements. OBJECTIVES We aimed to determine whether the substitution of a 1.5-kcal/mL enteral nutrition solution for a 1.0-kcal/mL solution resulted in greater calorie delivery to critically ill patients and establish the feasibility of conducting a multicenter, double-blind, randomized trial to evaluate the effect of an increased calorie delivery on clinical outcomes. DESIGN A prospective, randomized, double-blind, parallel-group, multicenter study was conducted in 5 Australian intensive care units. One hundred twelve mechanically ventilated patients expected to receive enteral nutrition for ≥2 d were randomly assigned to receive 1.5 (n = 57) or 1.0 (n = 55) kcal/mL enteral nutrition solution at a rate of 1 mL/kg ideal body weight per hour for 10 d. Protein and fiber contents in the 2 solutions were equivalent. RESULTS The 2 groups had similar baseline characteristics (1.5 compared with 1.0 kcal/mL). The mean (±SD) age was 56.4 ± 16.8 compared with 56.5 ± 16.1 y, 74% compared with 75% were men, and the Acute Physiology and Chronic Health Evaluation II score was 23 ± 9.1 compared with 22 ± 8.9. The groups received similar volumes of enteral nutrition solution [1221 mL/d (95% CI: 1120, 1322 mL/d) compared with 1259 mL/d (95% CI: 1143, 1374 mL/d); P = 0.628], which led to a 46% increase in daily calories in the group given the 1.5-kcal/mL solution [1832 kcal/d (95% CI: 1681, 1984 kcal/d) compared with 1259 kcal/d (95% CI: 1143, 1374 kcal/d); P < 0.001]. The 1.5-kcal/mL solution was not associated with larger gastric residual volumes or diarrhea. In this feasibility study, there was a trend to a reduced 90-d mortality in patients given 1.5 kcal/mL [11 patients (20%) compared with 20 patients (37%); P = 0.057]. CONCLUSIONS The substitution of a 1.0- with a 1.5-kcal/mL enteral nutrition solution administered at the same rate resulted in a 46% greater calorie delivery without adverse effects. The results support the conduct of a large-scale trial to evaluate the effect of increased calorie delivery on clinically important outcomes in the critically ill.