EAT-ICU
Trial question
What is the role of early goal-directed nutrition in acutely admitted, mechanically ventilated, adult ICU patients?
Study design
Single center
Open label
RCT
Population
Characteristics of study participants
38.0% female
62.0% male
N = 199
199 patients (75 female, 124 male).
Inclusion criteria: acutely admitted, mechanically ventilated ICU patients expected to stay > 3 days in the ICU.
Key exclusion criteria: a BMI ≤ 17 kg/m² or malnutrition.
Interventions
N=100 early goal-directed nutrition (estimation of nutritional requirements by indirect calorimetry and 24-hour urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition).
N=99 standard of care (aim to provide 25 kcal/kg/day by enteral nutrition).
Primary outcome
Physical Component Summary score at 6 months
22.9
23
23.0
17.3
11.5
5.8
0.0
Early goal-directed
nutrition
Standard of
care
No significant
difference ↔
No significant difference in Physical Component Summary score at 6 months (22.9 vs. 23).
Secondary outcomes
No significant difference in death at 6 months (37% vs. 34%; RR 1.08, 95% CI 0.74 to 1.57).
No significant difference in new organ failure in the ICU (81% vs. 78%; RR 1.04, 95% CI 0.9 to 1.2).
No significant difference in new use of RRT in the ICU (22% vs. 17%; RR 1.28, 95% CI 0.73 to 2.26).
Safety outcomes
No significant difference in any nosocomial infections.
Significant difference in cumulative insulin dose in the ICU (86 IU vs. 0 IU) and at least one episode of hyperglycemia (52% vs. 25%).
Conclusion
In acutely admitted, mechanically ventilated ICU patients expected to stay > 3 days in the ICU, early goal-directed nutrition was not superior to standard of care with respect to Physical Component Summary score at 6 months.
Reference
Matilde Jo Allingstrup, Jens Kondrup, Jørgen Wiis et al. 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 Med. 2017 Nov;43(11):1637-1647.
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