Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial.
BACKGROUND
Optimal nutrition of critically ill patients is still a matter of debate. This pilot trial aimed to compare the impact of normocaloric vs hypocaloric feeding in critically ill patients in the first 7 days in the intensive care unit (ICU). The primary end point was the rate of nosocomial infections during the ICU stay.


METHODS
Critically ill patients requiring artificial nutrition for at least 72 hours were included within 24 hours of ICU admission and randomized into a normocaloric group (receiving 100% of their daily energy expenditure) and a hypocaloric group (receiving 50% of their daily energy expenditure).


RESULTS
One hundred patients were included (54 in the normocaloric group and 46 in the hypocaloric group). There were 66 male and 34 female patients with a mean age of 65.8 ± 11.6 years. The mean daily caloric supply was 19.7 ± 5.7 kcal/kg for the normocaloric group and 11.3 ± 3.1 kcal/kg for the hypocaloric group (P = .0001). Insulin demand was significantly higher and gastrointestinal intolerance more frequent in the normocaloric group than in the hypocaloric group. Nosocomial infections were detected more frequently in the hypocaloric group than in the normocaloric group (26.1% vs 11.1%, respectively). The ICU mortality rate was 22.2% in the normocaloric group and 21.7% in the hypocaloric group (not significant). The hospital mortality rate was 31.5% in the normocaloric group and 37.0% in the hypocaloric group (P = .67).


CONCLUSION
Hypocaloric feeding in the first 7 days in critically ill patients was associated with more nosocomial infections but less insulin demand and less gastrointestinal intolerance compared with normocaloric feeding.


TRIAL REGISTRATION NUMBER
DRKS00000104 (German Clinical Trials Register).
['Petros|Sirak|S|', 'Horbach|Monika|M|', 'Seidel|Frank|F|', 'Weidhase|Lorenz|L|']
D000368:Aged D016638:Critical Illness D003428:Cross Infection D004040:Dietary Carbohydrates D004041:Dietary Fats D004044:Dietary Proteins D023381:Endpoint Determination D002149:Energy Intake D004734:Energy Metabolism D004750:Enteral Nutrition D005260:Female D017052:Hospital Mortality D006801:Humans D007362:Intensive Care Units D007902:Length of Stay D016015:Logistic Models D008297:Male D044342:Malnutrition D008875:Middle Aged D009751:Nutritional Requirements D009752:Nutritional Status D018529:Nutritional Support D010288:Parenteral Nutrition D010865:Pilot Projects D011446:Prospective Studies D016896:Treatment Outcome
nutrition critical illness hypocaloric feeding normocaloric feeding outcome