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Targeted Full Energy and Protein Delivery in Critically Ill Patients: A Pilot Randomized Controlled Trial (FEED Trial)
Author(s) -
Fetterplace Kate,
Deane Adam M.,
Tierney Audrey,
Beach Lisa J.,
Knight Laura D.,
Presneill Jeffrey,
Rechnitzer Thomas,
Forsyth Adrienne,
Gill Benjamin M. T.,
Mourtzakis Marina,
MacIsaac Christopher
Publication year - 2018
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1166
Subject(s) - medicine , randomized controlled trial , parenteral nutrition , intensive care unit , enteral administration , malnutrition , clinical trial , intensive care , protein–energy malnutrition , nutritional supplementation , medical nutrition therapy , intensive care medicine
Background International guidelines recommend greater protein delivery to critically ill patients than they currently receive. This pilot randomized clinical trial aimed to determine whether a volume‐target enteral protocol with supplemental protein delivered greater amounts of protein and energy to critically ill patients compared with standard care. Methods Sixty participants received either the intervention (volume‐based protocol, with protein supplementation) or standard nutrition care (hourly‐rate‐based protocol, without protein supplementation) in the intensive care unit (ICU). Coprimary outcomes were average daily protein and energy delivery. Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) and malnutrition (subjective global assessment) at ICU discharge. Results Mean (SD) protein and energy delivery per day from nutrition therapy for the intervention were 1.2 (0.30) g/kg and 21 (5.2) kcal/kg compared with 0.75 (0.11) g/kg and 18 (2.7) kcal/kg for standard care. The mean difference between groups in protein and energy delivery per day was 0.45 g/kg (95% CI, 0.33–0.56; P < .001) and 2.8 kcal/kg (95% CI, 0.67–4.9, P = .01). Muscle loss (QMLT) at discharge was attenuated by 0.22 cm (95% CI, 0.06–0.38, P = .01) in patients receiving the intervention compared with standard care. The number of malnourished patients was fewer in the intervention [2 (7%) vs 8 (28%); P = .04]. Mortality and duration of admission were similar between groups. Conclusions A high‐protein volume‐based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge.