In the past year, there have been a few large-scale trials of nutrition support in the critical care setting that have produced negative results and have challenged certain assumptions. The purpose of this study is to review those current trials and illustrate key methodological points that should help with the interpretation of these trials, and inform the design of critical care nutrition trials of artificial nutrition in the future.
Many recent and historical randomized trials of nutrition support in the ICU setting fail to consider which patients may benefit the most from artificial nutrition support (nutrition risk assessment) and longer-term outcomes such as return to physical function and health-related quality of life.
Future trials of nutrition support in the ICU, such as the TOP UP study, should include only ‘high-risk’ patients and should evaluate a broader range of outcomes than traditional ICU outcomes (28-day mortality, ventilator-free days, organ failure-free days, etc.). In the meantime, efforts to improve delivery of energy and protein to critically ill patients, such as with the enhanced protein-energy provision via the enteral route feeding protocol, are warranted.
aDepartment of Medicine
bDepartment of Community Health and Epidemiology, Queen's University
cClinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada
Correspondence to Daren K. Heyland, Angada 4, Kingston General Hospital, Kingston, ON K7L 2V7, Canada. Tel: +1 6135496666x4847; fax: +1 6135482428