EJRC ARTICLE REVIEW

Individualised goal-directed nutrition therapy has been suggested as a potentially beneficial strategy in improving outcomes in ICU patients, but to date, no randomised trials have assessed the effects of individualising energy and protein supply to ICU patients based on measured requirements.

The EAT-ICU trial performed in Copenhagen university hospital in Denmark between June 2013 and October 2016 aimed to examine whether patients who received early goal-directed nutrition (EGDN) would have an improved overall physical wellbeing 6 months after ICU discharge as compared to those who received standard nutrition. The study included patients who were mechanically ventilated and expected to stay for more than 3 days in the adult ICU. Patients (n=203) were randomised into 2 groups: Early goal-directed nutrition (EGDN) group (101 patients) and standard group (102). In the EGDN group, patients received their nutrition according to measured energy expenditure using indirect calorimetry, which was done every other day-aiming to deliver 100% of the nutritional needs measured, while the standard group received the standard calculated 25 kcal/kg/d. Both groups received their nutrition by enteral feeding within the first 24 hours with or without parental nutrition if necessary.

Results showed that the EGDN group received more of their daily energy and protein goals compared to those allocated to the standard of care group. However the investigators found no difference between the two groups in the physical quality of life after 6 months, as measured by the physical component summary (PCS). More patients in the EGDN group experienced hyperglycaemia, hence the cumulative dose of insulin administered was higher in the

EGDN group as compared to the standard of care group. There was no difference between the two groups regarding the length of stay, mortality, nosocomial infections, need for ventilator/ inotropic support or the development of organ failure.

Limitations of the EAT-ICU study include that it was done in a single ICU setting hence results may not be generalisable to other ICUs. Masking of the nutritional regimen allocated was not feasible from clinical staff, so full blinding was not possible, and this might have led to bias. Finally the investigators had some data for primary outcome missing (23 patients) and had to impute it.

Take home messages

• Patients who received goal directed nutritional support using indirect calorimetry had less energy and protein deficits compared to the standard 25 kcal/kg/d.
• There was no difference in physical quality of life at 6 months, mortality, need for inotropic or ventilatory support, nosocomial infections and length of stay between the EGDN and standard groups
• EGDN group had more hyperglycaemia and insulin requirements compared to the standard group

This article review was prepared and submitted by EJRC member Mohamed Omar Elghonemi.

Reference

Matilde Jo Allingstrup et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded (EAT-ICU trial). Intensive Care Med, Seven-Day Profile Publication, Vol 43, 11 / November, 2017, 1637 – 1647 DOI: 10.1007/s00134-017-4880-3