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Title: Outcomes Six-Months After 100% or 70% of Enteral Calorie Requirements During Critical Illness (TARGET): A Randomized Controlled Trial.
Austin Authors: 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
Affiliation: University of Michigan Department of Internal Medicine, 173243, Division of Pulmonary and Critical Care Medicine, Ann Arbor, Michigan, United States
The University of Adelaide Adelaide Medical School, 110466, Centre of Research Excellence in Translating Nutritional Science to Good Health, Adelaide, South Australia, Australia
Royal Melbourne Hospital, 90134, Department of Medicine, Melbourne, Victoria, Australia
Medical Research Institute of New Zealand, 194581, Wellington, New Zealand
The University of Adelaide Discipline of Acute Care Medicine, 242032, Adelaide, South Australia, Australia
Australian National University, 2219, Medical School, Canberra, Australian Capital Territory, Australia
The University of Melbourne Melbourne Medical School, 276235, Department of Medicine and Radiology, Melbourne, Victoria, Australia
Fiona Stanley Hospital, 418838, Intensive Care Unit, Murdoch, Western Australia, Australia
University of Adelaide Faculty of Health Sciences, 50072, Discipline of Acute Care Medicine, Adelaide, South Australia, Australia
Royal Melbourne Hospital, 90134, Intensive Care Unit, Melbourne, Victoria, Australia
Monash University School of Public Health and Preventive Medicine, 161667, Australian and New Zealand Intensive Care Research Centre, Melbourne, Victoria, Australia
Royal Adelaide Hospital, 1062, Adelaide, South Australia, Australia
Intensive Care Unit, Austin Health, Heidelberg, Victoria, Australia
Royal Prince Alfred Hospital, 2205, Department of Nutrition & Dietetics, Camperdown, New South Wales, Australia
Issue Date: 6-Jan-2020 2020
Publication information: American Journal of Respiratory and Critical Care Medicine 2020; online first: 6 January
Abstract: 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, ID: NCT02306746.
DOI: 10.1164/rccm.201909-1810OC
ORCID: 0000-0002-7620-5577
PubMed URL: 31904995
Type: Journal Article
Subjects: critical illness
disability and health
enteral nutrition
quality of life
Appears in Collections:Journal articles

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