Journal
NEW ENGLAND JOURNAL OF MEDICINE
Volume 372, Issue 25, Pages 2398-2408Publisher
MASSACHUSETTS MEDICAL SOC
DOI: 10.1056/NEJMoa1502826
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- King Abdullah International Medical Research Center
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BACKGROUND The appropriate caloric goal for critically ill adults is unclear. We evaluated the effect of restriction of nonprotein calories (permissive underfeeding), as compared with standard enteral feeding, on 90-day mortality among critically ill adults, with maintenance of the full recommended amount of protein in both groups. METHODS At seven centers, we randomly assigned 894 critically ill adults with a medical, surgical, or trauma admission category to permissive underfeeding (40 to 60% of calculated caloric requirements) or standard enteral feeding (70 to 100%) for up to 14 days while maintaining a similar protein intake in the two groups. The primary outcome was 90-day mortality. RESULTS Baseline characteristics were similar in the two groups; 96.8% of the patients were receiving mechanical ventilation. During the intervention period, the permissive-underfeeding group received fewer mean (+/- SD) calories than did the standard-feeding group (835 +/- 297 kcal per day vs. 1299 +/- 467 kcal per day, P< 0.001; 46 +/- 14% vs. 71 +/- 22% of caloric requirements, P< 0.001). Protein intake was similar in the two groups (57 +/- 24 g per day and 59 +/- 25 g per day, respectively; P = 0.29). The 90-day mortality was similar: 121 of 445 patients (27.2%) in the permissive-underfeeding group and 127 of 440 patients (28.9%) in the standard-feeding group died (relative risk with permissive underfeeding, 0.94; 95% confidence interval [CI], 0.76 to 1.16; P = 0.58). No serious adverse events were reported; there were no significant between-group differences with respect to feeding intolerance, diarrhea, infections acquired in the intensive care unit (ICU), or ICU or hospital length of stay. CONCLUSIONS Enteral feeding to deliver a moderate amount of nonprotein calories to critically ill adults was not associated with lower mortality than that associated with planned delivery of a full amount of nonprotein calories.
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