Outcomes Six-Months After 100% or 70% of Enteral Calorie Requirements During Critical Illness (TARGET): A Randomized Controlled Trial.

2020-01-06

Deane, Adam M

Little, Lorraine

Bellomo, Rinaldo

Chapman, Marianne J

Davies, Andrew R

Ferrie, Suzie

Horowitz, Michael

Hurford, Sally

Lange, Kylie

Litton, Edward

Mackle, Diane

O'Connor, Stephanie

Parker, Jane

Peake, Sandra L

Presneill, Jeffrey J

Ridley, Emma J

Singh, Vanessa

van Haren, Frank

Williams, Patricia

Young, Paul

Iwashyna, Theodore J

critical illness

disability and health

enteral nutrition

quality of life

Journal Article

0000-0002-7620-5577

0000-0001-8037-4229

0000-0002-3428-3083

0000-0002-1650-8939

10.1164/rccm.201909-1810OC

The long-term effects of delivering approximately 100% of recommended calorie intake via the enteral route during critical illness compared to a lesser amount of calories are unknown. Our hypotheses were that achieving approximately 100% of recommended calorie intake during critical illness would increase quality of life scores, return to work and key life activities and reduce death and disability six months later. We conducted a multicenter, blinded, parallel group, randomized clinical trial, with 3957 mechanically ventilated critically ill adults allocated to energy-dense (1.5 kcal/ml) or routine (1.0 kcal/ml) enteral nutrition. Participants assigned energy-dense nutrition received more calories (% recommended energy intake, mean (SD) (energy-dense: 103% (28) vs. usual: 69% (18)). Mortality at day-180 was similar (560/1895 (29.6%) vs. 539/1920 (28.1%); relative risk 1.05 (95%CI, 0.95 to 1.16)). At a median [IQR] of 185 [182, 193] days after randomization, 2492 survivors were surveyed and reported similar quality of life (EuroQol five dimensions five-level quality of life questionnaire visual analogue scale, median [IQR]: 75 [60-85]; group difference: 0 (95%CI, 0 to 0)). Similar numbers of participants returned to work with no difference in hours worked or effectiveness at work (n=818). There was no observed difference in disability (n=1208) or participation in key life activities (n=705). The delivery of approximately 100% compared to 70% of recommended calorie intake during critical illness does not improve quality of life, or functional outcomes, or increase the number of survivors six months later. Clinical trial registration available at www.clinicaltrials.gov, ID: NCT02306746.

link

American Journal of Respiratory and Critical Care Medicine 2020; online first: 6 January

American Journal of Respiratory and Critical Care Medicine