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TICACOS international: A multi-center, randomized, prospective controlled study comparing tight calorie control
P Singer1, E De Waele2, C Sanchez3
1Department of Intensive Care, Institute for Nutrition Research, Rabin Medical Center, Beillison Hospital, Affiliated to the Sackler School of Medicine, Tel Aviv University, Israel.
Clinical Nutrition (Edinburgh, Scotland)
|June 15, 2020
Summary
Indirect calorimetry (IC) guided nutrition showed a trend toward reduced infection and mortality in critically ill patients. While not statistically significant, these findings may enhance future meta-analyses on IC
Area of Science:
- Critical Care Medicine
- Nutritional Support
- Metabolic Monitoring
Background:
- Indirect calorimetry (IC) measures resting energy expenditure (REE) for precise nutritional support.
- Previous studies and meta-analyses suggest a survival benefit for IC-guided nutrition in critically ill patients.
- Optimizing energy delivery is crucial for improving outcomes in intensive care unit (ICU) settings.
Purpose of the Study:
- To assess the added value of daily REE measurement via IC in guiding nutritional support for critically ill patients.
- To determine if IC-guided nutrition can decrease the infectious rate in this population.
- To evaluate the impact of IC-guided nutrition on other morbidities and mortality.
Main Methods:
- A multicenter, prospective, randomized, controlled, non-blinded study involving 417 adult ventilated ICU patients.
- Study group received nutritional support based on IC measurements; control group received nutrition based on predictive equations (20-25 kcal/kg ideal body weight/day).
- Primary endpoint was infection rate; secondary endpoints included mortality, length of stay, and ventilation duration.
Main Results:
- No significant differences were observed in infection rates (40% vs 31%), mortality (30 vs 21 deaths), or other secondary outcomes between the IC-guided and control groups.
- The study was stopped early due to a slow inclusion rate, with only 339 of 417 patients completing the protocol.
- A trend towards decreased mortality in the IC group was noted, potentially influenced by the study's limited sample size.
Conclusions:
- While not statistically significant, IC-guided nutrition demonstrated a trend towards decreased infection and mortality.
- The study's findings, combined with previous research, may contribute to improved meta-analysis results regarding IC's impact on mortality.
- Larger sample sizes may be necessary to definitively establish the benefits of IC-guided nutritional support in critically ill patients.
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