Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial.
PURPOSE
We assessed the effects of early goal-directed nutrition (EGDN) vs. standard nutritional care in adult intensive care unit (ICU) patients.


METHODS
We randomised acutely admitted, mechanically ventilated ICU patients expected to stay longer than 3 days in the ICU. In the EGDN group we estimated nutritional requirements by indirect calorimetry and 24-h urinary urea aiming at covering 100% of requirements from the first full trial day using enteral and parenteral nutrition. In the standard of care group we aimed at providing 25 kcal/kg/day by enteral nutrition. If this was not met by day 7, patients were supplemented with parenteral nutrition. The primary outcome was physical component summary (PCS) score of SF-36 at 6 months. We performed multiple imputation for data of the non-responders.


RESULTS
We randomised 203 patients and included 199 in the intention-to-treat analyses; baseline variables were reasonably balanced between the two groups. The EGDN group had less negative energy (p < 0.001) and protein (p < 0.001) balances in the ICU as compared to the standard of care group. The PCS score at 6 months did not differ between the two groups (mean difference 0.0, 95% CI -5.9 to 5.8, p = 0.99); neither did mortality, rates of organ failures, serious adverse reactions or infections in the ICU, length of ICU or hospital stay, or days alive without life support at 90 days.


CONCLUSIONS
EGDN did not appear to affect physical quality of life at 6 months or other important outcomes as compared to standard nutrition care in acutely admitted, mechanically ventilated, adult ICU patients. Clinicaltrials.gov identifier no. NCT01372176.
['Allingstrup|Matilde Jo|MJ|', 'Kondrup|Jens|J|', 'Wiis|Jørgen|J|', 'Claudius|Casper|C|', 'Pedersen|Ulf Gøttrup|UG|', 'Hein-Rasmussen|Rikke|R|', 'Bjerregaard|Mads Rye|MR|', 'Steensen|Morten|M|', 'Jensen|Tom Hartvig|TH|', 'Lange|Theis|T|', 'Madsen|Martin Bruun|MB|', 'Møller|Morten Hylander|MH|', 'Perner|Anders|A|http://orcid.org/0000-0002-4668-0123']
D000368:Aged D002151:Calorimetry D004044:Dietary Proteins D004750:Enteral Nutrition D005260:Female D006040:Goals D017052:Hospital Mortality D006801:Humans D007362:Intensive Care Units D057194:Intention to Treat Analysis D007902:Length of Stay D008297:Male D008875:Middle Aged D015596:Nutrition Assessment D009752:Nutritional Status D017063:Outcome Assessment, Health Care D010288:Parenteral Nutrition D011788:Quality of Life D016037:Single-Blind Method D059039:Standard of Care D014508:Urea
Nutrition Indirect calorimetry Protein Quality of life Clinical outcome Critical care