Erschienen in:
01.04.2011 | Original
The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients
verfasst von:
Pierre Singer, Ronit Anbar, Jonathan Cohen, Haim Shapiro, Michal Shalita-Chesner, Shaul Lev, Elad Grozovski, Miryam Theilla, Sigal Frishman, Zecharia Madar
Erschienen in:
Intensive Care Medicine
|
Ausgabe 4/2011
Einloggen, um Zugang zu erhalten
Abstract
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.