Lancet Respiratory
March 20, 2023
Low versus standard calorie and protein feeding in ventilated adults with shock
Mazen Kherallah
Summarized by:
What was the research question?
Population (P): Adults (≥18 years) in intensive care units (ICUs) receiving invasive mechanical ventilation and vasopressor support for shock.
Intervention (I): Early nutrition (started within 24 h after intubation) with low calorie and protein targets (6 kcal/kg per day and 0·2–0·4 g/kg per day protein).
Comparison (C): Standard calorie and protein targets (25 kcal/kg per day and 1·0–1·3 g/kg per day protein).
Outcome (O): Time to readiness for ICU discharge and day 90 all-cause mortality.
How did they do it?
Methodology: Pragmatic, randomized, controlled, multicentre, open-label, parallel-group trial conducted in 61 French ICUs.
Trial Groups: Low group: Early nutrition with low calorie and protein targets. Total participants: 1521.
Standard group: Early nutrition with standard calorie and protein targets. Total participants: 1515.Primary Outcome: Time to readiness for ICU discharge and day 90 all-cause mortality.
Secondary Outcomes: Secondary infections, gastrointestinal events, and liver dysfunction.
What were the results?
Primary Outcome: Mortality by day 90 was not significantly different between the two groups (41.3% in the low group vs 42.8% in the standard group) (absolute difference –1.5%, p=0.41).
Time to readiness for ICU discharge was significantly faster in the low group (median 8.0 days) compared to the standard group (median 9.0 days) (HR 1.12, p=0.015).
Secondary Outcomes:No significant difference in rates of secondary infections between the groups.
The low group experienced significantly fewer gastrointestinal complications, including vomiting, diarrhea, bowel ischaemia, and liver dysfunction.
Are there any limitations of the study?
Open-label design: Could introduce potential biases as both participants and researchers knew which intervention was being received.
Conducted only in French ICUs: Results may not be generalizable to ICUs in other countries with different standard protocols.
Potential unmeasured confounding factors could impact the results.
What does it mean?
Restricting early calorie and protein intake did not reduce mortality in severe critically ill patients but may accelerate recovery.
Fewer gastrointestinal complications suggest a potential advantage to the low-calorie/protein approach.