Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: A randomized controlled trial

Eric J. Charles, Robin T. Petroze, Rosemarie Metzger, Tjasa Hranjec, Laura H. Rosenberger, Lin M. Riccio, Matthew D. McLeod, Christopher A. Guidry, George J. Stukenborg, Brian R. Swenson, Kate F. Willcutts, Kelly B. O'Donnell, Robert G. Sawyer

Research output: Contribution to journalArticle

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Abstract

Background: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. Objective: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. Design: Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg-1 · d-1 (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg-1 · d-1). Results: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (±SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. Conclusions: Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.

Original languageEnglish (US)
Pages (from-to)1337-1343
Number of pages7
JournalAmerican Journal of Clinical Nutrition
Volume100
Issue number5
DOIs
StatePublished - Nov 1 2014

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Nutritional Support
Critical Care
Intensive Care Units
Randomized Controlled Trials
Infection
Critical Illness
Length of Stay
Overnutrition
Parenteral Nutrition
Energy Intake
Hyperglycemia
Small Intestine
Glucose
Mortality
Proteins

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Medicine(all)

Cite this

Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit : A randomized controlled trial. / Charles, Eric J.; Petroze, Robin T.; Metzger, Rosemarie; Hranjec, Tjasa; Rosenberger, Laura H.; Riccio, Lin M.; McLeod, Matthew D.; Guidry, Christopher A.; Stukenborg, George J.; Swenson, Brian R.; Willcutts, Kate F.; O'Donnell, Kelly B.; Sawyer, Robert G.

In: American Journal of Clinical Nutrition, Vol. 100, No. 5, 01.11.2014, p. 1337-1343.

Research output: Contribution to journalArticle

Charles, EJ, Petroze, RT, Metzger, R, Hranjec, T, Rosenberger, LH, Riccio, LM, McLeod, MD, Guidry, CA, Stukenborg, GJ, Swenson, BR, Willcutts, KF, O'Donnell, KB & Sawyer, RG 2014, 'Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: A randomized controlled trial', American Journal of Clinical Nutrition, vol. 100, no. 5, pp. 1337-1343. https://doi.org/10.3945/ajcn.114.088609
Charles, Eric J. ; Petroze, Robin T. ; Metzger, Rosemarie ; Hranjec, Tjasa ; Rosenberger, Laura H. ; Riccio, Lin M. ; McLeod, Matthew D. ; Guidry, Christopher A. ; Stukenborg, George J. ; Swenson, Brian R. ; Willcutts, Kate F. ; O'Donnell, Kelly B. ; Sawyer, Robert G. / Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit : A randomized controlled trial. In: American Journal of Clinical Nutrition. 2014 ; Vol. 100, No. 5. pp. 1337-1343.
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abstract = "Background: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. Objective: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. Design: Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg-1 · d-1 (eucaloric) or 50{\%} of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg-1 · d-1). Results: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (±SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7{\%} (29 of 41) and 76.2{\%} (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3{\%}) and 4 (9.5{\%}), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. Conclusions: Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.",
author = "Charles, {Eric J.} and Petroze, {Robin T.} and Rosemarie Metzger and Tjasa Hranjec and Rosenberger, {Laura H.} and Riccio, {Lin M.} and McLeod, {Matthew D.} and Guidry, {Christopher A.} and Stukenborg, {George J.} and Swenson, {Brian R.} and Willcutts, {Kate F.} and O'Donnell, {Kelly B.} and Sawyer, {Robert G.}",
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T2 - A randomized controlled trial

AU - Charles, Eric J.

AU - Petroze, Robin T.

AU - Metzger, Rosemarie

AU - Hranjec, Tjasa

AU - Rosenberger, Laura H.

AU - Riccio, Lin M.

AU - McLeod, Matthew D.

AU - Guidry, Christopher A.

AU - Stukenborg, George J.

AU - Swenson, Brian R.

AU - Willcutts, Kate F.

AU - O'Donnell, Kelly B.

AU - Sawyer, Robert G.

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N2 - Background: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. Objective: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. Design: Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg-1 · d-1 (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg-1 · d-1). Results: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (±SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. Conclusions: Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.

AB - Background: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. Objective: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. Design: Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg-1 · d-1 (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg-1 · d-1). Results: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (±SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. Conclusions: Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.

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