Optimization of Nutrition Therapy with the Use of Calorimetry to Determine and Control Energy Needs in Mechanically Ventilated Critically Ill Patients: The ONCA Study, a Randomized, Prospective Pilot Study
Abstract
Background: Adequate nutrition therapy in critically ill patients poses a challenge because of the variable energy and substrate needs. The objective was to investigate whether nutrition therapy involving indirect calorimetry (IC), instead of equations for assessment of energy needs, could improve the nutrition status of critically ill patients. Methods: Forty mechanically ventilated patients were randomized into a group in which energy needs were controlled by calorimetry (IC group) and a group treated with a formula‐based approach reflecting standard care (SC group). The primary outcome was change in the phase angle (PhA), a bioelectrical impedance parameter related to nutrition status and prognosis. Results: The mean IC‐based energy requirement was lower than the formula‐based estimate (21.1 ± 6.4 versus [vs] 25 kcal/kg/d, P < .01). The IC group reached 98% ± 8% of the energy goal, whereas the SC group reached only 79% ± 29% (P < 0.05), although mean intake was similar in both groups. The protein intake goal was better met in the IC group (91% ± 24%) than the SC group (73% ± 33%). The PhA of the IC group did not change during treatment, whereas that of the SC group tended to decrease by 0.36° ± 0.86° (P = .077). A shorter length of stay in intensive care was observed in the IC than in the SC group (13 ± 8 vs 24 ± 20 days, P < .05). Conclusion: Intensified individual nutrition therapy involving IC appears to be useful for improving nutrition status in critically ill patients.
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Some included RCTs reached 100% of the IC targets in the first 24 hours after randomization.
“In the current study, some included RCTs reached 100% of the IC targets in the first 24 h after randomization [7, 21].”
From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [21]
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- Authors
- Gonzalez‐Granda, A., Schollenberger, A., Haap, M., Riessen, R., & Bischoff, S. C.
- Affiliations
- University of Hohenheim (DE)
- University of Tübingen (DE)
- Corresponding author
- Bischoff, Stephan C.
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2018-09-25
- Volume
- 43
- Issue
- 4
- Pages
- 481-489
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- OpenAlex
- W2893171254
- Cited by
- 40
- References
- 44
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 3 · 2022: 3 · 2021: 11 · 2020: 7 · 2019: 4
- FWCI
- 4.55
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Keywords
- indirect calorimetry, nutritional therapy, critically ill patients, mechanical ventilation, phase angle, bioimpedance, protein intake, ICU length of stay, enteral nutrition
- MeSH terms
- Adult, Aged, Energy Intake, Calorimetry, Indirect, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Nutritional Requirements, Pilot Projects, Prospective Studies, Respiration, Artificial, Critical Illness, Treatment Outcome, Nutrition Therapy
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