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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

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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.

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Titel: 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
Publikationsdatum: 01.04.2011
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 4/2011
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-011-2146-z

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The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients