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Association of energy delivery with short-term survival in mechanically ventilated critically ill adult patients: a secondary analysis of the NEED trial

European Journal of Clinical Nutrition volume 78, pages 257–263 (2024)Cite this article

Subjects

Abstract

Background and aims

The optimal energy delivery for mechanically ventilated patients is controversial, particularly during the first week of ICU admission. This study aimed to investigate the association between different caloric adequacy and 28-day mortality in a cohort of critically ill adults on mechanical ventilation.

Methods

This is a secondary analysis of a multicenter, cluster-randomized controlled trial. Eligible patients were divided into four quartiles (Q1-Q4) according to caloric adequacy calculated by the actual average daily energy delivery during the first seven days of ICU stay divided by energy requirement as a percentage. Cox proportional hazards models were used to examine the impact of different quartiles of caloric adequacy on 28-day mortality in the whole cohort and subgroups with different nutritional risk status at enrollment.

Results

A total of 1587 patients were included in this study, with an overall 28-day mortality of 15.8%. The average caloric adequacy was 26.3 ± 11.9% (Q1), 52.5 ± 5.5% (Q2), 71.7 ± 6.4% (Q3), 107.0 ± 22.2% (Q4), respectively (p < 0.001 among quartiles). Compared with Q1, Q3 was associated with lower mortality in the unadjusted model (hazard ratio [HR] = 0.536; 95% confidence interval [CI], 0.375–0.767; P = 0.001) and adjusted model (adjusted HR = 0.508; 95% CI, 0.339–0.761; P = 0.001). This association remained valid in the subgroup of high nutritional risk patients (unadjusted HR = 0.387; 95% CI, 0.238–0.627; P < 0.001 and adjusted HR = 0.369; 95% CI, 0.216–0.630; P < 0.001, respectively), but not in those with low risk.

Conclusions

Energy delivery near the 70% energy requirements in the first week of ICU stay was associated with reduced 28-day mortality among mechanically ventilated critically ill patients, especially in patients with high nutrition risk at admission.

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Fig. 1: Flowchart of patient selection.
Fig. 2: Kaplan-Meier survival curves for the association of energy adequacy with primary outcome.
Fig. 3: Dose-effect association between increasing energy adequacy and 28-day mortality.

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Data availability

The data sets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request and approval from the ethics committee.

References

  1. Allen K, Hoffman L. Enteral nutrition in the mechanically ventilated patient. Nutr Clin Pract. 2019;34:540–57.

    Article  PubMed  Google Scholar 

  2. Heyland DK, Dhaliwal R, Drover JW, Gramlich L, Dodek P. Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Parenter Enter Nutr. 2003;27:355–73.

    Article  Google Scholar 

  3. Reid C. Frequency of under- and overfeeding in mechanically ventilated ICU patients: causes and possible consequences. J Hum Nutr Diet. 2006;19:13–22.

    Article  CAS  PubMed  Google Scholar 

  4. Rubinson L, Diette GB, Song X, Brower RG, Krishnan JA. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med. 2004;32:350–7.

    Article  PubMed  Google Scholar 

  5. Compher C, Bingham AL, McCall M, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. J Parenter Enter Nutr. 2022;46:12–41.

    Article  CAS  Google Scholar 

  6. Chapman M, Peake SL, Bellomo R, Davies A, Deane A, Horowitz M, et al. Energy-dense versus routine enteral nutrition in the critically Ill. N Engl J Med. 2018;379:1823–34.

    Article  PubMed  Google Scholar 

  7. Braunschweig CA, Sheean PM, Peterson SJ, Gomez Perez S, Freels S, Lateef O, et al. Intensive nutrition in acute lung injury: a clinical trial (INTACT). J Parenter Enter Nutr. 2015;39:13–20.

    Article  Google Scholar 

  8. Marik PE, Hooper MH. Normocaloric versus hypocaloric feeding on the outcomes of ICU patients: a systematic review and meta-analysis. Intensive Care Med. 2016;42:316–23.

    Article  PubMed  Google Scholar 

  9. Marik PE, Hooper MH. Normocaloric versus hypocaloric feeding in ICU patients: response to comments by Bitzani. Intensive Care Med. 2016;42:630.

    Article  PubMed  Google Scholar 

  10. Ke L, Lin J, Doig GS, van Zanten ARH, Wang Y, Xing J, et al. Actively implementing an evidence-based feeding guideline for critically ill patients (NEED): a multicenter, cluster-randomized, controlled trial. Crit Care. 2022;26:46.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Oh C, Chung W, Hong B. A simple equation for ideal body weight. Eur J Anaesthesiol. 2021;38:671–3.

    Article  PubMed  Google Scholar 

  12. Zusman O, Theilla M, Cohen J, Kagan I, Bendavid I, Singer P. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care. 2016;20:367.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Rice TW, Wheeler AP, Thompson BT, Steingrub J, Hite RD, Moss M, et al. Initial trophic vs full enteral feeding in patients with acute lung injury: the EDEN randomized trial. JAMA. 2012;307:795–803.

    Article  PubMed  Google Scholar 

  14. Rugeles S, Villarraga-Angulo LG, Ariza-Gutiérrez A, Chaverra-Kornerup S, Lasalvia P, Rosselli D. High-protein hypocaloric vs normocaloric enteral nutrition in critically ill patients: a randomized clinical trial. J Crit Care. 2016;35:110–4.

    Article  PubMed  Google Scholar 

  15. Petros S, Horbach M, Seidel F, Weidhase L. Hypocaloric vs normocaloric nutrition in critically Ill patients: a prospective randomized pilot trial. J Parenter Enter Nutr. 2016;40:242–9.

    Article  CAS  Google Scholar 

  16. Van Dyck L, Casaer MP, Gunst J. Autophagy and its implications against early full nutrition support in critical illness. Nutr Clin Pract. 2018;33:339–47.

    Article  PubMed  Google Scholar 

  17. Gunst J. Recovery from critical illness-induced organ failure: the role of autophagy. Crit Care. 2017;21:209.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Allingstrup MJ, Kondrup J, Wiis J, Claudius C, Pedersen UG, Hein-Rasmussen R, 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;43:1637–47.

    Article  PubMed  Google Scholar 

  19. Turina M, Fry DE, Polk HC. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med. 2005;33:1624–33.

    Article  PubMed  Google Scholar 

  20. Ng RRG, Myat Oo A, Liu W, Tan TE, Ti LK, Chew STH. Changing glucose control target and risk of surgical site infection in a Southeast Asian population. J Thorac Cardiovasc Surg. 2015;149:323–8.

    Article  PubMed  Google Scholar 

  21. Diamanti-Kandarakis E, Papalou O, Kandaraki EA, Kassi G. MECHANISMS IN ENDOCRINOLOGY: Nutrition as a mediator of oxidative stress in metabolic and reproductive disorders in women. Eur J Endocrinol. 2017;176:R79–R99.

    Article  CAS  PubMed  Google Scholar 

  22. Peterson SJ, Lateef OB, Freels S, McKeever L, Fantuzzi G, Braunschweig CA. Early exposure to recommended calorie delivery in the intensive care unit is associated with increased mortality in patients with acute respiratory distress syndrome. J Parenter Enter Nutr. 2018;42:739–47.

    Article  Google Scholar 

  23. Pichard C, Oshima T, Berger MM. Energy deficit is clinically relevant for critically ill patients: yes. Intensive Care Med. 2015;41:335–8.

    Article  PubMed  Google Scholar 

  24. Kinney JM. Metabolic responses of the critically ill patient. Crit Care Clin. 1995;11:569–85.

    Article  CAS  PubMed  Google Scholar 

  25. Singer P, Blaser AR, Berger MM, Calder PC, Casaer M, Hiesmayr M, et al. ESPEN practical and partially revised guideline: clinical nutrition in the intensive care unit. Clin Nutr (Edinb, Scotl). 2023;42:1671–89.

    Article  Google Scholar 

  26. Ridley EJ, Peake SL, Jarvis M, Deane AM, Lange K, Davies AR, et al. Nutrition therapy in Australia and New Zealand intensive care units: an international comparison study. JPEN J Parenter Enter Nutr. 2018;42:1349–57.

    Article  Google Scholar 

  27. Reignier J, Plantefeve G, Mira J-P, Argaud L, Asfar P, Aissaoui N, et al. Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med. 2023;11:602–12.

    Article  CAS  PubMed  Google Scholar 

  28. Arabi YM, Aldawood AS, Al-Dorzi HM, Tamim HM, Haddad SH, Jones G, et al. Permissive underfeeding or standard enteral feeding in high- and low-nutritional-risk critically Ill adults. Post hoc analysis of the PermiT Trial. Am J Respir Crit Care Med. 2017;195:652–62.

    Article  CAS  PubMed  Google Scholar 

  29. Wang C-Y, Fu P-K, Chao W-C, Wang W-N, Chen C-H, Huang Y-C. Full versus trophic feeds in critically Ill adults with high and low nutritional risk scores: a randomized controlled trial. Nutrients. 2020;12:3518.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rahman A, Hasan RM, Agarwala R, Martin C, Day AG, Heyland DK. Identifying critically-ill patients who will benefit most from nutritional therapy: Further validation of the “modified NUTRIC” nutritional risk assessment tool. Clin Nutr. 2016;35:158–62.

    Article  PubMed  Google Scholar 

  31. Wischmeyer, Bear DE PE, Berger MM, De Waele E, Gunst J, McClave SA, et al. Personalized nutrition therapy in critical care: 10 expert recommendations. Crit Care. 2023;27:261.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Oshima T, Delsoglio M, Dupertuis YM, Singer P, De Waele E, Veraar C, et al. The clinical evaluation of the new indirect calorimeter developed by the ICALIC project. Clin Nutr. 2020;39:3105–11.

    Article  PubMed  Google Scholar 

  33. Sundström Rehal M, Tatucu-Babet OA, Oosterveld T. Indirect calorimetry: should it be part of routine care or only used in specific situations? Curr Opin Clin Nutr Metab Care. 2023;26:154–9.

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to acknowledge all the patients and health staff who participated in the original trial.

Funding

This research was funded by the National Natural Science Foundation of China (82070665) and the Major Program of Military Logistics Research Plan (ALB18J001).

Author information

Author notes

  1. These authors contributed equally: Lanting Wang, Yi Long.

Authors and Affiliations

  1. Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

    Lanting Wang, Zixiong Zhang, Jiajia Lin, Jing Zhou, Gang Li, Bo Ye, He Zhang, Lin Gao, Zhihui Tong, Weiqin Li & Lu Ke

  2. Department of Critical Care Medicine, Chongqing University Cancer Hospital, Chongqing, China

    Yi Long & Zhengying Jiang

  3. National Institute of Healthcare Data Science, Nanjing University, Nanjing, China

    Weiqin Li & Lu Ke

  4. Sir Run Run Shaw Hospital, Hangzhou, China

    Feng Guo

  5. Liverpool School of Tropical Medicine, Liverpool, UK

    Tao Chen

  6. BenQ Medical Center, Nanjing, China

    Juan Xing

  7. First People’s Hospital of Foshan, Foshan, China

    Lixin Zhou

  8. First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China

    Jiandong Lin

  9. Suzhou Municipal Hospital, Suzhou, China

    Jun Liu

  10. North China University of Science and Technology Affiliated Hospital, Tangshan, China

    Yafeng Liang

  11. Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China

    Peiyang Gao

  12. Luoyang Central Hospital, Luoyang, China

    Junli Sun

  13. Changzhou No. 2 People’s Hospital, Changzhou, China

    Wenming Liu

  14. The Second Affiliated Hospital of Harbin Medical University, Harbin, China

    Zhenyu Yang

  15. Zibo Central Hospital, Zibo, China

    Rumin Zhang

  16. The Third Xiangya Hospital of Central South University, Changsha, China

    Wei Xing

  17. The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    An Zhang

  18. First People’s Hospital of Kunming, Kunming, China

    Zhigang Zhou

  19. Linyi City People Hospital, Linyi, China

    Tingfa Zhou

  20. Tangshan Gongren Hospital, Tangshan, China

    Yang Liu

  21. Hebei Medical University Second Affiliated Hospital, Hebei, China

    Fei Tong

  22. Wuxi People’s Hospital, Wuxi, China

    Qiuhui Wang

  23. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Rongqing Sun

Authors
  1. Lanting Wang
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  8. He Zhang
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Consortia

the Chinese Critical Care Nutrition Trials Group (CCCNTG)

  • Lu Ke
  • , Jiajia Lin
  • , Zhihui Tong
  • , Weiqin Li
  • , Lanting Wang
  • , Yi Long
  • , Zhengying Jiang
  • , Feng Guo
  • , Tao Chen
  • , Juan Xing
  • , Lixin Zhou
  • , Jiandong Lin
  • , Jun Liu
  • , Yafeng Liang
  • , Peiyang Gao
  • , Junli Sun
  • , Wenming Liu
  • , Zhenyu Yang
  • , Rumin Zhang
  • , Wei Xing
  • , An Zhang
  • , Zhigang Zhou
  • , Tingfa Zhou
  • , Yang Liu
  • , Fei Tong
  • , Qiuhui Wang
  •  & Rongqing Sun

Contributions

JJL, LK, WQL and ZYJ contributed to the conceptualization and design of the study; LTW, YL and ZXZ contributed to the acquisition and analysis of data; LTW, JZ, GL, BY, HZ, LG and ZHT contributed to the interpretation of data; LTW drafted the manuscript; LK and ZYJ provided critical edits to the manuscript. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to Lu Ke or Zhengying Jiang.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was a secondary analysis of a cluster-randomized controlled trial (ISRCTN registry: ISRCTN12233792), which was approved by the ethics committee of Jinling Hospital (2017NZKY-010-01).

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Wang, L., Long, Y., Zhang, Z. et al. Association of energy delivery with short-term survival in mechanically ventilated critically ill adult patients: a secondary analysis of the NEED trial. Eur J Clin Nutr 78, 257–263 (2024). https://doi.org/10.1038/s41430-023-01369-6

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  • DOI: https://doi.org/10.1038/s41430-023-01369-6

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