Nutrition in critical care · How much to feed
Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Permissive underfeeding delivering a moderate proportion of calorie requirements with full protein |
| Control | Standard enteral feeding delivering full calories |
| Population | 894 critically ill adults, 96.8% of whom were mechanically ventilated |
| Follow-up | 90 days |
| Primary endpoint | 90-day all-cause mortality |
| Result | The permissive-underfeeding group received 835±297 kcal per day versus 1299±467 (p<0.001), or 46±14% versus 71±22% of caloric requirements. Protein intake was similar (57±24 versus 59±25 g per day, p=0.29). Ninety-day mortality was 121 of 445 (27.2%) versus 127 of 440 (28.9%) — relative risk 0.94 (95% CI 0.76 to 1.16, p=0.58). |
| Secondary endpoints | Infections, ICU and hospital length of stay, feeding intolerance |
Enteral feeding to deliver a moderate amount of nonprotein calories to critically ill adults was not associated with lower mortality than that associated with planned delivery of a full amount of nonprotein calories.
The trial authors, in the published abstract
Completes the picture from EPaNIC and EDEN: within a wide range, calorie delivery in early critical illness simply does not determine outcome. Protein was held constant here, which is why the protein trials had to be done separately.
Arabi YM, Aldawood AS, Haddad SH, et al. Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. N Engl J Med 2015 Jun 18;372(25):2398-408.