Chapman M, et al. – Investigators conducted this multicenter, double-blind, randomized trial to test the premise that delivering a larger number of calories with the use of energy-dense enteral nutrition in patients receiving mechanical ventilation would result in higher rates of survival within 90 days vs routine care. They found that the rate of survival at 90 days related to the use of an energy-dense formulation for enteral delivery of nutrition was not higher vs routine enteral nutrition in those undergoing mechanical ventilation.

Methods

• This trial involved adults undergoing mechanical ventilation in 46 Australian and New Zealand intensive care units (ICUs) to assess energy-dense (1.5 kcal/mL) vs routine (1.0 kcal/mL) enteral nutrition at a dose of 1 mL/kg of ideal body weight per hour, commencing at or within 12 hours of the initiation of nutrition support and continuing for up to 28 days while the patient was in the ICU.
• All-cause mortality within 90 days was the primary outcome.

Results

• A total of 3,957 patients were included in the modified intention-to-treat analysis (1,971 in the 1.5-kcal group and 1,986 in the 1.0-kcal group).
• Findings revealed that the volume of enteral nutrition delivered during the trial was comparable in the two groups.
• However, patients in the 1.5-kcal group received a mean (± SD) of 1,863 ± 478 kcal per day vs 1,262 ± 313 kcal per day in the 1.0-kcal group (mean difference, 601 kcal per day; 95% CI: 576-626).
• An aggregate of 523 of 1948 patients (26.8%) in the 1.5-kcal group and 505 of 1966 patients (25.7%) in the 1.0-kcal group died (relative risk, 1.05; 95% CI: 0.94-1.16; P=0.41) by day 90.
• In seven predefined subgroups, the outcomes were comparable.
• It was noted that higher calorie delivery did not affect survival time, receipt of organ support, number of days alive and out of the ICU and hospital or free of organ support, or the incidence of infective complications or adverse events.