Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial
Open accessAbstract
Background Enteral nutrition (EN) is recommended for patients in the intensive-care unit (ICU), but it does not consistently achieve nutritional goals. We assessed whether delivery of 100% of the energy target from days 4 to 8 in the ICU with EN plus supplemental parenteral nutrition (SPN) could optimise clinical outcome.Methods This randomised controlled trial was undertaken in two centres in Switzerland. We enrolled patients on day 3 of admission to the ICU who had received less than 60% of their energy target from EN, were expected to stay for longer than 5 days, and to survive for longer than 7 days. We calculated energy targets with indirect calorimetry on day 3, or if not possible, set targets as 25 and 30 kcal per kg of ideal bodyweight a day for women and men, respectively. Patients were randomly assigned (1:1) by a computer-generated randomisation sequence to receive EN or SPN. The primary outcome was occurrence of nosocomial infection after cessation of intervention (day 8), measured until end of follow-up (day 28), analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00802503.Findings We randomly assigned 153 patients to SPN and 152 to EN. 30 patients discontinued before the study end. Mean energy delivery between day 4 and 8 was 28 kcal/kg per day (SD 5) for the SPN group (103% [SD 18%] of energy target), compared with 20 kcal/kg per day (7) for the EN group (77% [27%]). Between days 9 and 28, 41 (27%) of 153 patients in the SPN group had a nosocomial infection compared with 58 (38%) of 152 patients in the EN group (hazard ratio 0·65, 95% CI 0·43-0·97; p=0·0338), and the SPN group had a lower mean number of nosocomial infections per patient (-0·42 [-0·79 to -0·05]; p=0·0248).Interpretation Individually optimised energy supplementation with SPN starting 4 days after ICU admission could reduce nosocomial infections and should be considered as a strategy to improve clinical outcome in patients in the ICU for whom EN is insufficient.Funding Foundation Nutrition 2000Plus, ICU Quality Funds, Baxter, and Fresenius Kabi.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The pilot TICACOS study showed that an indirect calorimetry strategy was associated with improvement in 60-day survival in the per-protocol study, but also with increase in length of ventilation, infections and length of stay related to calorie overload and positive energy balance.
“The pilot TICACOS study (126) showed that such a strategy was associated with an improvement in 60 day survival in the per protocol study, but also to an increase in length of ventilation, infections and length of stay related to the calorie overload and positive energy balance due to non-nutritional energy intakes.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [126]
Heidegger et al. measured EE at day 3 and adapted the energy intake accordingly, comparing supplemental PN from day four to an EN only group; the intervention group had a lower late nosocomial infection rate after day 9.
“Heidegger et al. [48] measured EE at day 3 and adapted the energy intake accordingly, comparing supplemental PN from day four to an EN only group.The intervention group had a lower late nosocomial infection rate after day 9.”
From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [48]
The SPN study measured REE by IC on day 3 to guide PN supplement and found that delivery of 100% of the energy target from days 4 with EN plus supplemental PN significantly reduced nosocomial infections.
“A previous large RCT (SPN study) measured REE by IC on day 3 to guide PN supplement and found the delivery of 100% of the energy target from days 4 with EN plus supplemental PN significantly reduced nosocomial infections [9].”
From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [9]
Further RCTs using IC as an energy target showed significant reduction in nosocomial infections and improved immunity or less systemic inflammation.
“Results from further RCTs using IC as a energy target showed significant reduction in nosocomial infections [9] and improved immunity or less systemic inflammation [5].”
From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [9]
Cites
Controlling the False Discovery Rate: A Practical and Powerful Approach to Multiple Testing
Benjamini, Y., & Hochberg, Y. (1995) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1995.tb02031.x · Cited by 109,482 · see citing works
Early versus late parenteral nutrition in critically ill adults
Casaer, M. P., Mesotten, D., Hermans, G., Wouters, P. J., Schetz, M., Meyfroidt, G., Van Cromphaut, S., Ingels, C., Meersseman, P., Muller, J., et al. (2011) · New England Journal of Medicine · doi:10.1056/nejmoa1102662 · Cited by 1,696 · see citing works
Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients
Villet, S., Chiolero, R. L., Bollmann, M. D., Revelly, J.-P., Cayeux RN, M.-C., Delarue, J., & Berger, M. M. (2005) · Clinical Nutrition · doi:10.1016/j.clnu.2005.03.006 · Cited by 995 · see citing works
Self-citation
Flagged first, then by citations
Cited by
Sorted by citations
McClave, S. A., Taylor, B. E., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Journal of Parenteral and Enteral Nutrition · doi:10.1177/0148607115621863 · Cited by 3,982 · see citing works
ESPEN guideline on clinical nutrition in the intensive care unit.
Singer, P., Blaser, A. R., Berger, M. M., Alhazzani, W., Calder, P. C., Casaer, M. P., Hiesmayr, M., Mayer, K., Montejo, J. C., Pichard, C., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2018.08.037 · Cited by 2,904 · see citing works
Self-citationAcute skeletal muscle wasting in critical illness
Puthucheary, Z. A., Rawal, J., McPhail, M., Connolly, B., Ratnayake, G., Chan, P., Hopkinson, N. S., Padhke, R., Dew, T., Sidhu, P. S., et al. (2013) · JAMA · doi:10.1001/jama.2013.278481 · Cited by 2,103 · see citing works
Taylor, B. E., McClave, S. A., Martindale, R. G., Warren, M. M., Johnson, D. R., Braunschweig, C., McCarthy, M. S., Davanos, E., Rice, T. W., Cresci, G. A., et al. (2016) · Critical Care Medicine · doi:10.1097/ccm.0000000000001525 · Cited by 1,476 · see citing works
ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit
Singer, P., Blaser, A. R., Berger, M. M., Calder, P. C., Casaer, M., Hiesmayr, M., Mayer, K., Montejo-Gonzalez, J. C., Pichard, C., Preiser, J.-C., et al. (2023) · Clinical Nutrition · doi:10.1016/j.clnu.2023.07.011 · Cited by 793 · see citing works
Self-citationTrial of the Route of Early Nutritional Support in Critically Ill Adults
Harvey, S. E., Parrott, F., Harrison, D. A., Bear, D. E., Segaran, E., Beale, R., Bellingan, G., Leonard, R., Mythen, M. G., & Rowan, K. M. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1409860 · Cited by 618 · see citing works
Early versus late parenteral nutrition in critically ill children
Fivez, T., Kerklaan, D., Mesotten, D., Verbruggen, S., Wouters, P. J., Vanhorebeek, I., Debaveye, Y., Vlasselaers, D., Desmet, L., Casaer, M. P., et al. (2016) · New England Journal of Medicine · doi:10.1056/nejmoa1514762 · Cited by 558 · see citing works
Zusman, O., Theilla, M., Cohen, J., Kagan, I., Bendavid, I., & Singer, P. (2016) · Critical Care · doi:10.1186/s13054-016-1538-4 · Cited by 421 · see citing works
Metabolic and nutritional support of critically ill patients: consensus and controversies
Preiser, J.-C., van Zanten, A. R., Berger, M. M., Biolo, G., Casaer, M. P., Doig, G. S., Griffiths, R. D., Heyland, D. K., Hiesmayr, M., Iapichino, G., et al. (2015) · Critical Care · doi:10.1186/s13054-015-0737-8 · Cited by 416 · see citing works
Self-citationWeijs, P. J., Looijaard, W. G., Beishuizen, A., Girbes, A. R., & Oudemans-van Straaten, H. M. (2014) · Critical Care · doi:10.1186/s13054-014-0701-z · Cited by 358 · see citing works
Energy-dense versus routine enteral nutrition in the critically ill
The TARGET Investigators (2018) · New England Journal of Medicine · doi:10.1056/nejmoa1811687 · Cited by 345 · see citing works
Allingstrup, M. J., Kondrup, J., Wiis, J., Claudius, C., Pedersen, U. G., Hein-Rasmussen, R., Bjerregaard, M. R., Steensen, M., Jensen, T. H., Lange, T., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4880-3 · Cited by 341 · see citing works
Nutrition in the acute phase of critical illness
Casaer, M. P., & Van den Berghe, G. (2014) · New England Journal of Medicine · doi:10.1056/nejmra1304623 · Cited by 335 · see citing works
Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group
Oshima, T., Berger, M. M., De Waele, E., Guttormsen, A. B., Heidegger, C.-P., Hiesmayr, M., Singer, P., Wernerman, J., & Pichard, C. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.06.010 · Cited by 283 · see citing works
Self-citationCompher, C., Chittams, J., Sammarco, T., Nicolo, M., & Heyland, D. K. (2017) · Critical Care Medicine · doi:10.1097/ccm.0000000000002083 · Cited by 264 · see citing works
NutritionDay ICU: a 7 year worldwide prevalence study of nutrition practice in intensive care
Bendavid, I., Singer, P., Theilla, M., Themessl-Huber, M., Sulz, I., Mouhieddine, M., Schuh, C., Mora, B., & Hiesmayr, M. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.07.012 · Cited by 175 · see citing works
A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice
Preiser, J.-C., Arabi, Y. M., Berger, M. M., Casaer, M., McClave, S., Montejo-González, J. C., Peake, S., Reintam Blaser, A., Van den Berghe, G., van Zanten, A., et al. (2021) · Critical Care · doi:10.1186/s13054-021-03847-4 · Cited by 166 · see citing works
Self-citationWischmeyer, P. E., Hasselmann, M., Kummerlen, C., Kozar, R., Kutsogiannis, D. J., Karvellas, C. J., Besecker, B., Evans, D. K., Preiser, J.-C., Gramlich, L., et al. (2017) · Critical Care · doi:10.1186/s13054-017-1736-8 · Cited by 153 · see citing works
Charles, E. J., Petroze, R. T., Metzger, R., Hranjec, T., Rosenberger, L. H., Riccio, L. M., McLeod, M. D., Guidry, C. A., Stukenborg, G. J., Swenson, B. R., et al. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.114.088609 · Cited by 122 · see citing works
Tailoring nutrition therapy to illness and recovery
Wischmeyer, P. E. (2017) · Critical Care · doi:10.1186/s13054-017-1906-8 · Cited by 131 · see citing works
Duan, J.-Y., Zheng, W.-H., Zhou, H., Xu, Y., & Huang, H.-B. (2021) · Critical Care · doi:10.1186/s13054-021-03508-6 · Cited by 122 · see citing works
Rugeles, S., Villarraga-Angulo, L. G., Ariza-Gutiérrez, A., Chaverra-Kornerup, S., Lasalvia, P., & Rosselli, D. (2016) · Journal of Critical Care · doi:10.1016/j.jcrc.2016.05.004 · Cited by 103 · see citing works
Rugeles, S.-J., Rueda, J.-D., Díaz, C.-E., & Rosselli, D. (2013) · Indian Journal of Critical Care Medicine · doi:10.4103/0972-5229.123438 · Cited by 101 · see citing works
“There is still controversy regarding the accurate nutritional therapy for critically ill patients, specially the amount of calories and the types of nutrients required.[11,22,23]”
Loss of appetite in acutely ill medical inpatients: physiological response or therapeutic target?
Schütz, P., Bally, M., Stanga, Z., & Keller, U. (2014) · Swiss Medical Weekly · doi:10.4414/smw.2014.13957 · Cited by 78 · see citing works
Peake, S. L., Davies, A. R., Deane, A. M., Lange, K., Moran, J. L., O’Connor, S. N., Ridley, E. J., Williams, P. J., & Chapman, M. J. (2014) · The American Journal of Clinical Nutrition · doi:10.3945/ajcn.114.086322 · Cited by 71 · see citing works
Autophagy and Its Implications Against Early Full Nutrition Support in Critical Illness
Van Dyck, L., Casaer, M. P., & Gunst, J. (2018) · Nutrition in Clinical Practice · doi:10.1002/ncp.10084 · Cited by 70 · see citing works
Soeters, P., Bozzetti, F., Cynober, L., Elia, M., Shenkin, A., & Sobotka, L. (2016) · Clinical Nutrition · doi:10.1016/j.clnu.2015.08.008 · Cited by 40 · see citing works
Sabatino, A., Fiaccadori, E., Barazzoni, R., Carrero, J. J., Cupisti, A., De Waele, E., Jonckheer, J., Cuerda, C., & Bischoff, S. C. (2024) · Clinical Nutrition · doi:10.1016/j.clnu.2024.08.002 · Cited by 40 · see citing works
Feeding should be individualized in the critically ill patients
Berger, M. M., & Pichard, C. (2019) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000625 · Cited by 37 · see citing works
Self-citation
- Authors
- Heidegger, C. P., Berger, M. M., Graf, S., Zingg, W., Darmon, P., Costanza, M. C., Thibault, R., & Pichard, C.
- Affiliations
- University Hospital of Geneva (CH)
- Centre Hospitalier Universitaire Vaudois (CH)
- University of Vermont (US)
- Corresponding author
- Pichard, Claude
- ORCID
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 381
- Issue
- 9864
- Pages
- 385-393
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- OpenAlex
- W2136953347
- Cited by
- 776
- References
- 3
- Citations by year
- 2026: 19 · 2025: 43 · 2024: 34 · 2023: 39 · 2022: 39 · 2021: 52 · 2020: 65 · 2019: 51 · 2018: 56 · 2017: 72 · 2016: 66 · 2015: 84 · 2014: 92 · 2013: 60 · 2012: 1
- FWCI
- 70.80
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- The Lancet (publishedVersion)
- PubMed (publishedVersion)
- Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
- IRIS (submittedVersion)
- SERVAL (Université de Lausanne) (submittedVersion)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
- Keywords
- supplemental parenteral nutrition, enteral nutrition, energy targets, energy optimization, critically ill patients, intensive care unit, nosocomial infections, indirect calorimetry, nutritional support, infection control
- MeSH terms
- Energy Intake, Cross Infection, Dietary Proteins, Enteral Nutrition, Female, Humans, Intensive Care Units, Male, Middle Aged, Parenteral Nutrition, Critical Illness
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
