Targeted full energy and protein delivery in critically ill patients : A pilot randomized controlled trial (FEED Trial)

Journal article


Fetterplace, Kate, Deane, Adam, Tierney, Audrey, Beach, Lisa J., Knight, Laura D., Presneill, Jeffrey, Rechnitzer, Thomas, Forsyth, Adrienne, Gill, Benjamin, Mourtzakis, Marina and MacIsaac, Christopher. (2018). Targeted full energy and protein delivery in critically ill patients : A pilot randomized controlled trial (FEED Trial). Journal of Parenteral and Enteral Nutrition. 42(8), pp. 1252-1262. https://doi.org/10.1002/jpen.1166
AuthorsFetterplace, Kate, Deane, Adam, Tierney, Audrey, Beach, Lisa J., Knight, Laura D., Presneill, Jeffrey, Rechnitzer, Thomas, Forsyth, Adrienne, Gill, Benjamin, Mourtzakis, Marina and MacIsaac, Christopher
Abstract

Background
International guidelines recommend greater protein delivery to critically ill patients than they currently receive. This pilot randomized clinical trial aimed to determine whether a volume-target enteral protocol with supplemental protein delivered greater amounts of protein and energy to critically ill patients compared with standard care.

Methods
Sixty participants received either the intervention (volume-based protocol, with protein supplementation) or standard nutrition care (hourly-rate-based protocol, without protein supplementation) in the intensive care unit (ICU). Coprimary outcomes were average daily protein and energy delivery. Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) and malnutrition (subjective global assessment) at ICU discharge.

Results
Mean (SD) protein and energy delivery per day from nutrition therapy for the intervention were 1.2 (0.30) g/kg and 21 (5.2) kcal/kg compared with 0.75 (0.11) g/kg and 18 (2.7) kcal/kg for standard care. The mean difference between groups in protein and energy delivery per day was 0.45 g/kg (95% CI, 0.33–0.56; P < .001) and 2.8 kcal/kg (95% CI, 0.67–4.9, P = .01). Muscle loss (QMLT) at discharge was attenuated by 0.22 cm (95% CI, 0.06–0.38, P = .01) in patients receiving the intervention compared with standard care. The number of malnourished patients was fewer in the intervention [2 (7%) vs 8 (28%); P = .04]. Mortality and duration of admission were similar between groups.

Conclusions
A high-protein volume-based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge.

Keywordscritical illness; dietary proteins; enteral nutrition; enteral formulas; functional outcomes; muscle mass; nutrition support; ultrasound
Year2018
JournalJournal of Parenteral and Enteral Nutrition
Journal citation42 (8), pp. 1252-1262
PublisherJohn Wiley & Sons, Inc.
ISSN0148-6071
Digital Object Identifier (DOI)https://doi.org/10.1002/jpen.1166
Scopus EID2-s2.0-85055518634
Open accessPublished as green open access
Research or scholarlyResearch
Page range1252-1262
FunderMelbourne Health Foundation
Author's accepted manuscript
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All rights reserved
File Access Level
Open
Publisher's version
License
All rights reserved
File Access Level
Controlled
Output statusPublished
Publication dates
Online27 Apr 2018
Publication process dates
Accepted27 Feb 2018
Deposited22 Aug 2022
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