Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial

Matilde Jo Allingstrup; Jens Kondrup; Jørgen Wiis; Casper Claudius; Ulf Gøttrup Pedersen; Rikke Hein-Rasmussen; Mads Rye Bjerregaard; Morten Steensen; Tom Hartvig Jensen; Theis Lange; Martin Bruun Madsen; Morten Hylander Møller; Anders Perner

doi:10.1007/s00134-017-4880-3

Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial

Matilde Jo Allingstrup, Jens Kondrup, Jørgen Wiis, Casper Claudius, Ulf Gøttrup Pedersen, Rikke Hein-Rasmussen, Mads Rye Bjerregaard, Morten Steensen, Tom Hartvig Jensen, Theis Lange, Martin Bruun Madsen, Morten Hylander Møller, Anders Perner

108 Citations (Scopus)

Abstract

Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline variables were reasonably balanced between the two groups. The EGDN group had less negative energy (p < 0.001) and protein (p < 0.001) balances in the ICU as compared to the standard of care group. The PCS score at 6 months did not differ between the two groups (mean difference 0.0, 95% CI −5.9 to 5.8, p = 0.99); neither did mortality, rates of organ failures, serious adverse reactions or infections in the ICU, length of ICU or hospital stay, or days alive without life support at 90 days. Conclusions: EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients. Clinicaltrials.gov identifier no. NCT01372176.

Original language	English
Journal	Intensive Care Medicine
Volume	43
Issue number	11
Pages (from-to)	1637-1647
ISSN	0342-4642
DOIs	https://doi.org/10.1007/s00134-017-4880-3
Publication status	Published - 1 Nov 2017

Keywords

Critical care
Nutrition
Protein
Indirect calorimetry
Quality of life
Clinical outcome

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10.1007/s00134-017-4880-3

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Allingstrup, M. J., Kondrup, J., Wiis, J., Claudius, C., Pedersen, U. G., Hein-Rasmussen, R., Bjerregaard, M. R., Steensen, M., Jensen, T. H., Lange, T., Madsen, M. B., Møller, M. H., & Perner, A. (2017). Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Medicine, 43(11), 1637-1647. https://doi.org/10.1007/s00134-017-4880-3

Early goal-directed nutrition versus standard of care in adult intensive care patients : the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. / Allingstrup, Matilde Jo; Kondrup, Jens; Wiis, Jørgen et al.

In: Intensive Care Medicine, Vol. 43, No. 11, 01.11.2017, p. 1637-1647.

Research output: Contribution to journal › Journal article › Research › peer-review

Allingstrup, MJ, Kondrup, J, Wiis, J, Claudius, C, Pedersen, UG, Hein-Rasmussen, R, Bjerregaard, MR, Steensen, M, Jensen, TH, Lange, T, Madsen, MB, Møller, MH & Perner, A 2017, 'Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial', Intensive Care Medicine, vol. 43, no. 11, pp. 1637-1647. https://doi.org/10.1007/s00134-017-4880-3

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abstract = "Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline variables were reasonably balanced between the two groups. The EGDN group had less negative energy (p < 0.001) and protein (p < 0.001) balances in the ICU as compared to the standard of care group. The PCS score at 6 months did not differ between the two groups (mean difference 0.0, 95% CI −5.9 to 5.8, p = 0.99); neither did mortality, rates of organ failures, serious adverse reactions or infections in the ICU, length of ICU or hospital stay, or days alive without life support at 90 days. Conclusions: EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients. Clinicaltrials.gov identifier no. NCT01372176.",

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T2 - the single-centre, randomised, outcome assessor-blinded EAT-ICU trial

AU - Allingstrup, Matilde Jo

AU - Kondrup, Jens

AU - Wiis, Jørgen

AU - Claudius, Casper

AU - Pedersen, Ulf Gøttrup

AU - Hein-Rasmussen, Rikke

AU - Bjerregaard, Mads Rye

AU - Steensen, Morten

AU - Jensen, Tom Hartvig

AU - Lange, Theis

AU - Madsen, Martin Bruun

AU - Møller, Morten Hylander

AU - Perner, Anders

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N2 - Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline variables were reasonably balanced between the two groups. The EGDN group had less negative energy (p < 0.001) and protein (p < 0.001) balances in the ICU as compared to the standard of care group. The PCS score at 6 months did not differ between the two groups (mean difference 0.0, 95% CI −5.9 to 5.8, p = 0.99); neither did mortality, rates of organ failures, serious adverse reactions or infections in the ICU, length of ICU or hospital stay, or days alive without life support at 90 days. Conclusions: EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients. Clinicaltrials.gov identifier no. NCT01372176.

AB - Purpose: We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients. Methods: We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders. Results: We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline variables were reasonably balanced between the two groups. The EGDN group had less negative energy (p < 0.001) and protein (p < 0.001) balances in the ICU as compared to the standard of care group. The PCS score at 6 months did not differ between the two groups (mean difference 0.0, 95% CI −5.9 to 5.8, p = 0.99); neither did mortality, rates of organ failures, serious adverse reactions or infections in the ICU, length of ICU or hospital stay, or days alive without life support at 90 days. Conclusions: EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients. Clinicaltrials.gov identifier no. NCT01372176.

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KW - Nutrition

KW - Protein

KW - Indirect calorimetry

KW - Quality of life

KW - Clinical outcome

U2 - 10.1007/s00134-017-4880-3

DO - 10.1007/s00134-017-4880-3

M3 - Journal article

C2 - 28936712

SN - 0935-1701

VL - 43

SP - 1637

EP - 1647

JO - European Journal of Intensive Care Medicine

JF - European Journal of Intensive Care Medicine

IS - 11

ER -

Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial

Abstract

Keywords

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