Table 1 Randomised controlled trials of nutrition in critically ill patients reporting physical and functional outcomes
| Â | NHLBI et al., 2012 [3] | Needham et al., 2013 [37] | Casaer et al., 2013 [39] | Hermans et al., 2013a [31] | Doig et al., 2013 [40] | Harvey et al., 2014 [2] | Wei et al., 2015 [38] | Doig et al., 2015 [41] | Ferrie et al., 2016 [42] |
|---|---|---|---|---|---|---|---|---|---|
Patient population | N = 1000 ALI | N = 174 ALI from EDEN cohort | N = 15 Neurosurgical patients from EPaNIC cohort | N = 600 30% cardiac surgery | N = 1372 45.85% emergency surgery 19.9% elective surgery | N = 2400 13% surgical | N = 475 78% medical | N = 339 64.5% medical 24% emergency surgical 12% elective surgical | N = 129 Requiring PN |
Study design | Multicentre, 44-site RCT | Multicentre, 5-site follow-up from EDEN | Prospective sub-study of large RCT | Sub-study from EPaNIC | Multicentre, 31-site RCT | Multicentre, 33-site pragmatic RCT | Retrospective analysis from REDOXs | Multicentre, 13-site RCT | Single-centre RCT |
Duration of intervention | 6Â days | 6Â days | 9Â days | 10Â days | NR | 5Â days (120Â hours) | 8Â days | 7Â days | Up to 10Â days |
Age, years (mean) | Trophic feeding: 52 Full feeding: 52 | Trophic feeding: 48 Full feeding: 47 | Early PN: 44 Late PN: 50 | Early PN: 62 Late PN: 65 (median) | Standard care: 68.6 Early PN: 68.4 | PN: 63.3 EN: 62.9 | Low nutritional adequacy: 62 Moderate nutritional adequacy: 62 High nutritional adequacy: 65 | Standard: 61 Restricted: 59 | 0.8Â g/kg amino acids: 64.5 1.2Â g/kg amino acids: 67.0 |
BMI | Trophic feeding: 29.9 Full feeding: 30.4 | Trophic feeding: 31 Full feeding: 32 | Early PN: 24 Late PN: 25 | Early PN: 25 Late PN: 24.9 (median) | Standard care: 28.5 Early PN: 27.9 | PN: 27.7 EN: 28.2 | Low nutritional adequacy: 29.7 Moderate nutritional adequacy: 30.4 High nutritional adequacy: 29.3 | Standard: 28 Restricted: 28 | 0.8Â g/kg amino acids: 27.4 1.2Â g/kg amino acids: 25.7 |
APACHE II score | NR | NR | Early PN: 28 Late PN: 30 | Early PN: 32 Late PN: 30 (median) | Standard care: 21.5 Early PN: 20.5 | PN: 15.1 EN: 15.2 | Low nutritional adequacy: 27.2 Moderate nutritional adequacy: 26.8 High nutritional adequacy: 26.6 | Standard: 18 Restricted: 18 | 0.8Â g/kg amino acids: 23.7 1.2Â g/kg amino acids: 25.5 |
Mortalityb (%) | Trophic feeding: 23.2 (60Â days) Full feeding: 22.2 (60Â days) | Trophic feeding: 2 Full feeding: 7 (before 6-month follow-up) | Early PN: 20 Late PN: 0 (90Â days) | Early PN: 13 Late PN: 10 | Standard care: 14.66 Early PN: 11.89 | PN: 26.6 EN: 29.4 | Low nutritional adequacy: 26 Moderate nutritional adequacy: 27 High nutritional adequacy: 23 | Standard: 9 Restricted: 5 | 0.8Â g/kg amino acids: 6 1.2Â g/kg amino acids: 8 |
LOS (ICU)c | NR | Trophic feeding: 15.8 Full feeding:13.4 | Early PN: 12 Late PN: 9 | Early PN: 11 Late PN: 13 | Standard care: 9.3 (mean) Early PN: 8.2 (mean) | PN: 8.1Â days EN: 7.3Â days | Low nutritional adequacy: 18 Moderate nutritional adequacy: 19 High nutritional adequacy: 18 | Standard: 10.0 (mean) Restricted: 11.4 (mean) | 0.8Â g/kg amino acids: 6.0 1.2Â g/kg amino acids: 5.0 |
Provision of energy | Trophic feeding: 400 kcal/day Full feeding: 1300 kcal/day | NR | Early PN: approximately 21 kcal/kg Late PN: approximately 14 kcal/kg (over period of CT scans) | Overall total NR Early PN: < 30 kcal/kg/day Late PN: < 25 kcal/kg/day | Overall total not reported, but < 1600 kcal/day | PN: 21 kcal/kg/day EN: 18.5 kcal/kg/day | Mean for each group NR, but overall 56% | Overall total NR Standard: < 1600 kcal/day each day Restricted: < 1400 kcal/day each day | 0.8 g/kg amino acids: 24.9 kcal/kg 1.2 g/kg amino acids: 23.1 kcal/kg (first 7 days only) |
Provision of protein | NR | NR | NR | Overall total NR Early PN < 1.0 g/kg/day Late PN: < 0.9 g/kg/day | Total not reported, but 60 g/day | PN: 0.7 g/kg/day EN: 0.6 g/kg/day | Mean for each group NR, but overall 51% | Overall total NR Standard: < 60 g/day each day Restricted: < 55 g/day each day | 0.8 g/kg amino acids: 0.9 g/kg 1.2 g/kg amino acids: 1.09 g/kg |
Outcomes | ↑ number of patients discharged to rehabilitation facilities in trophic feeding group | No difference in physical function at 1 year | Early PN ↓ femoral muscle quality (increased intramuscular water/lipid content) at median of ICU day 9 | ↓ weakness on first assessment (median day 9) Faster recovery of weakness Favouring late PN | Improved SGA scores per week (↓ muscle wasting and ↓ fat loss) ↑ RAND-36 scores at 60 days All favouring early PN | No difference in HRQoL at 1 year using EQ-5D-5 L | Improved functional aspects of HRQoL at 3 months with improved nutritional adequacy | ↓ general health at day 90 in restricted caloric group using RAND- 36 survey | ↑ handgrip strength at day 7 ↓ muscle loss using muscle ultrasound at day 7 ↓ Chalder fatigue score at day 7 favouring high amino acid group |