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Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults.
N Engl J Med. 2015 Jun 18; 372(25):2398-408.NEJM

Abstract

BACKGROUND

The appropriate caloric goal for critically ill adults is unclear. We evaluated the effect of restriction of nonprotein calories (permissive underfeeding), as compared with standard enteral feeding, on 90-day mortality among critically ill adults, with maintenance of the full recommended amount of protein in both groups.

METHODS

At seven centers, we randomly assigned 894 critically ill adults with a medical, surgical, or trauma admission category to permissive underfeeding (40 to 60% of calculated caloric requirements) or standard enteral feeding (70 to 100%) for up to 14 days while maintaining a similar protein intake in the two groups. The primary outcome was 90-day mortality.

RESULTS

Baseline characteristics were similar in the two groups; 96.8% of the patients were receiving mechanical ventilation. During the intervention period, the permissive-underfeeding group received fewer mean (±SD) calories than did the standard-feeding group (835±297 kcal per day vs. 1299±467 kcal per day, P<0.001; 46±14% vs. 71±22% of caloric requirements, P<0.001). Protein intake was similar in the two groups (57±24 g per day and 59±25 g per day, respectively; P=0.29). The 90-day mortality was similar: 121 of 445 patients (27.2%) in the permissive-underfeeding group and 127 of 440 patients (28.9%) in the standard-feeding group died (relative risk with permissive underfeeding, 0.94; 95% confidence interval [CI], 0.76 to 1.16; P=0.58). No serious adverse events were reported; there were no significant between-group differences with respect to feeding intolerance, diarrhea, infections acquired in the intensive care unit (ICU), or ICU or hospital length of stay.

CONCLUSIONS

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. (Funded by the King Abdullah International Medical Research Center; PermiT Current Controlled Trials number, ISRCTN68144998.).

Authors+Show Affiliations

From King Saud bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center (Y.M.A., A.S.A., S.H.H., H.M.A.-D., H.M.T., M.H.S., M.S., L.A.), and King Faisal Specialist Hospital and Research Center (O.S.) - all in Riyadh, Saudi Arabia; the Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (H.M.T.); and the Department of Medicine, Division of Critical Care Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa (G.J., L.M.), and the Interdepartmental Division of Critical Care Medicine, Department of Medicine, Division of Respirology, University of Toronto, and Mount Sinai Hospital, Toronto (S.M.) - all in Canada.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25992505

Citation

Arabi, Yaseen M., et al. "Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults." The New England Journal of Medicine, vol. 372, no. 25, 2015, pp. 2398-408.
Arabi YM, Aldawood AS, Haddad SH, et al. Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. N Engl J Med. 2015;372(25):2398-408.
Arabi, Y. M., Aldawood, A. S., Haddad, S. H., Al-Dorzi, H. M., Tamim, H. M., Jones, G., Mehta, S., McIntyre, L., Solaiman, O., Sakkijha, M. H., Sadat, M., & Afesh, L. (2015). Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. The New England Journal of Medicine, 372(25), 2398-408. https://doi.org/10.1056/NEJMoa1502826
Arabi YM, et al. Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. N Engl J Med. 2015 Jun 18;372(25):2398-408. PubMed PMID: 25992505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. AU - Arabi,Yaseen M, AU - Aldawood,Abdulaziz S, AU - Haddad,Samir H, AU - Al-Dorzi,Hasan M, AU - Tamim,Hani M, AU - Jones,Gwynne, AU - Mehta,Sangeeta, AU - McIntyre,Lauralyn, AU - Solaiman,Othman, AU - Sakkijha,Maram H, AU - Sadat,Musharaf, AU - Afesh,Lara, AU - ,, Y1 - 2015/05/20/ PY - 2015/5/21/entrez PY - 2015/5/21/pubmed PY - 2015/6/25/medline SP - 2398 EP - 408 JF - The New England journal of medicine JO - N Engl J Med VL - 372 IS - 25 N2 - BACKGROUND: The appropriate caloric goal for critically ill adults is unclear. We evaluated the effect of restriction of nonprotein calories (permissive underfeeding), as compared with standard enteral feeding, on 90-day mortality among critically ill adults, with maintenance of the full recommended amount of protein in both groups. METHODS: At seven centers, we randomly assigned 894 critically ill adults with a medical, surgical, or trauma admission category to permissive underfeeding (40 to 60% of calculated caloric requirements) or standard enteral feeding (70 to 100%) for up to 14 days while maintaining a similar protein intake in the two groups. The primary outcome was 90-day mortality. RESULTS: Baseline characteristics were similar in the two groups; 96.8% of the patients were receiving mechanical ventilation. During the intervention period, the permissive-underfeeding group received fewer mean (±SD) calories than did the standard-feeding group (835±297 kcal per day vs. 1299±467 kcal per day, P<0.001; 46±14% vs. 71±22% of caloric requirements, P<0.001). Protein intake was similar in the two groups (57±24 g per day and 59±25 g per day, respectively; P=0.29). The 90-day mortality was similar: 121 of 445 patients (27.2%) in the permissive-underfeeding group and 127 of 440 patients (28.9%) in the standard-feeding group died (relative risk with permissive underfeeding, 0.94; 95% confidence interval [CI], 0.76 to 1.16; P=0.58). No serious adverse events were reported; there were no significant between-group differences with respect to feeding intolerance, diarrhea, infections acquired in the intensive care unit (ICU), or ICU or hospital length of stay. CONCLUSIONS: 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. (Funded by the King Abdullah International Medical Research Center; PermiT Current Controlled Trials number, ISRCTN68144998.). SN - 1533-4406 UR - https://www.unboundmedicine.com/medline/citation/25992505/Permissive_Underfeeding_or_Standard_Enteral_Feeding_in_Critically_Ill_Adults_ DB - PRIME DP - Unbound Medicine ER -