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Type: Journal article
Title: Use of a concentrated enteral nutrition solution to increase calorie delivery to critically ill patients: a randomized, double-blind, clinical trial
Author: Peake, S.
Davies, A.
Deane, A.
Lange, K.
Moran, J.
O'Connor, S.
Ridley, E.
Williams, P.
Chapman, M.
Citation: American Journal of Clinical Nutrition, 2014; 100(2):616-625
Publisher: American Society for Nutrition
Issue Date: 2014
ISSN: 0002-9165
Statement of
Sandra L Peake, Andrew R Davies, Adam M Deane, Kylie Lange, John L Moran, Stephanie N O'Connor, Emma J Ridley, Patricia J Williams, Marianne J Chapman, for the TARGET investigators and the Australian and New Zealand Intensive Care Society Clinical Trials Group
Abstract: BACKGROUND: Critically ill patients typically receive ∼60% of estimated calorie requirements.OBJECTIVES: We aimed to determine whether the substitution of a 1.5-kcal/mL enteral nutrition solution for a 1.0-kcal/mL solution resulted in greater calorie delivery to critically ill patients and establish the feasibility of conducting a multicenter, double-blind, randomized trial to evaluate the effect of an increased calorie delivery on clinical outcomes.DESIGN: A prospective, randomized, double-blind, parallel-group, multicenter study was conducted in 5 Australian intensive care units. One hundred twelve mechanically ventilated patients expected to receive enteral nutrition for ≥2 d were randomly assigned to receive 1.5 (n = 57) or 1.0 (n = 55) kcal/mL enteral nutrition solution at a rate of 1 mL/kg ideal body weight per hour for 10 d. Protein and fiber contents in the 2 solutions were equivalent.RESULTS: The 2 groups had similar baseline characteristics (1.5 compared with 1.0 kcal/mL). The mean (±SD) age was 56.4 ± 16.8 compared with 56.5 ± 16.1 y, 74% compared with 75% were men, and the Acute Physiology and Chronic Health Evaluation II score was 23 ± 9.1 compared with 22 ± 8.9. The groups received similar volumes of enteral nutrition solution [1221 mL/d (95% CI: 1120, 1322 mL/d) compared with 1259 mL/d (95% CI: 1143, 1374 mL/d); P = 0.628], which led to a 46% increase in daily calories in the group given the 1.5-kcal/mL solution [1832 kcal/d (95% CI: 1681, 1984 kcal/d) compared with 1259 kcal/d (95% CI: 1143, 1374 kcal/d); P < 0.001]. The 1.5-kcal/mL solution was not associated with larger gastric residual volumes or diarrhea. In this feasibility study, there was a trend to a reduced 90-d mortality in patients given 1.5 kcal/mL [11 patients (20%) compared with 20 patients (37%); P = 0.057].Conclusions: The substitution of a 1.0- with a 1.5-kcal/mL enteral nutrition solution administered at the same rate resulted in a 46% greater calorie delivery without adverse effects. The results support the conduct of a large-scale trial to evaluate the effect of increased calorie delivery on clinically important outcomes in the critically ill. This trial was registered at Australian New Zealand Clinical Trials ( as ACTRN 12611000793910.
Keywords: No keywords specified
Rights: © 2014 American Society for Nutrition
DOI: 10.3945/ajcn.114.086322
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