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Cited by 308Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsEnhanced Recovery After Surgery

Restricted versus continued standard caloric intake during the management of refeeding syndrome in critically ill adults: a randomised, parallel-group, multicentre, single-blind controlled trial

Doig, Gordon S, Simpson, Fiona, Heighes, Philippa T, Bellomo, Rinaldo, Chesher, Douglas, Caterson, Ian D, Reade, Michael C, Harrigan, Peter W J·2015·The Lancet Respiratory Medicine
DOI 10.1016/s2213-2600(15)00418-x
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Abstract

Background Equipoise exists regarding the benefits of restricting caloric intake during electrolyte replacement for refeeding syndrome, with half of intensive care specialists choosing to continue normal caloric intake. We aimed to assess whether energy restriction affects the duration of critical illness, and other measures of morbidity, compared with standard care. Methods We did a randomised, multicentre, single-blind clinical trial in 13 hospital intensive care units (ICUs) in Australia (11 sites) and New Zealand (two sites). Adult critically ill patients who developed refeeding syndrome within 72 h of commencing nutritional support in the ICU were enrolled and allocated to receive continued standard nutritional support or protocolised caloric restriction. 1:1 computer-based randomisation was done in blocks of variable size, stratified by enrolment serum phosphate concentration (>0·32 mmol/L vs ≤0·32 mmol/L) and body-mass index (BMI; >18 kg/m(2)vs ≤18 kg/m(2)). The primary outcome was the number of days alive after ICU discharge, with 60 day follow-up, in a modified intention-to-treat population of all randomly allocated patients except those mistakenly enrolled. Days alive after ICU discharge was a composite outcome based on ICU length of stay, overall survival time, and mortality. The Refeeding Syndrome Trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR number 12609001043224). Findings Between Dec 3, 2010, and Aug 13, 2014, we enrolled 339 adult critically ill patients: 170 were randomly allocated to continued standard nutritional support and 169 to protocolised caloric restriction. During the 60 day follow-up, the mean number of days alive after ICU discharge in 165 assessable patients in the standard care group was 39·9 (95% CI 36·4-43·7) compared with 44·8 (95% CI 40·9-49·1) in 166 assessable patients in the caloric restriction group (difference 4·9 days, 95% CI -2·3 to 13·6, p=0·19). Nevertheless, protocolised caloric restriction improved key individual components of the primary outcome: more patients were alive at day 60 (128 [78%] of 163 vs 149 [91%] of 164, p=0·002) and overall survival time was increased (48·9 [SD 1·46] days vs 53·65 [0·97] days, log-rank p=0·002). Interpretation Protocolised caloric restriction is a suitable therapeutic option for critically ill adults who develop refeeding syndrome. We did not identify any safety concerns associated with the use of protocolised caloric restriction. Funding National Health and Medical Research Council of Australia.

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Crossref · 10.1016/s2213-2600(15)00418-x

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  • The Top Up study did not find any difference in outcome between those achieving protein target versus controls.

    “The Top Up study (142) did not find any difference in outcome between those achieving protein target versus controls.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [142]

  • In a randomized controlled trial, Doig et al. showed that protocoled caloric restriction for 48 h in patients developing hypophosphatemia upon refeeding improved survival despite similar phosphate supplementation in both groups.

    “In a RCT, Doig et al. showed that protocoled caloric restriction for 48 h in patients developing hypophosphatemia upon refeeding improved survival despite similar phosphate supplementation in both groups [147].”

    From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [147]

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Authors
Doig, G. S., Simpson, F., Heighes, P. T., Bellomo, R., Chesher, D., Caterson, I. D., Reade, M. C., & Harrigan, P. W. J.
Affiliations
  • The University of Sydney (AU)
  • Monash University (AU)
  • NSW Health Pathology (AU)
  • The University of Queensland (AU)
  • John Hunter Hospital (AU)
Corresponding author
Doig, Gordon S
ORCID
Venue
The Lancet Respiratory Medicine
Publisher
Elsevier BV
Published
2015-12
Volume
3
Issue
12
Pages
943-952
ISSN
2213-2600 (ISSN-L)
DOI
10.1016/s2213-2600(15)00418-x
OpenAlex
W2211572974
Cited by
308
References
38
Citations by year
2026: 27 · 2025: 31 · 2024: 38 · 2023: 28 · 2022: 28 · 2021: 32 · 2020: 35 · 2019: 28 · 2018: 24 · 2017: 26 · 2016: 6 · 2015: 2
FWCI
17.08
Type
journal article
Language
en
Open access
closed
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • The Lancet Respiratory Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
Funders
National Health and Medical Research Council of Australia (project grant 632615)
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 › Surgery › Enhanced Recovery After Surgery
Keywords
refeeding syndrome, caloric restriction, intensive care nutrition, critically ill adults, nutritional support, electrolyte replacement, phosphate, mortality, length of hospital stay, overall survival, body mass index, critically ill children, neonatal intensive care, neonatal nutrition, neonatal mortality, neonatal length of stay
MeSH terms
Energy Intake, Female, Humans, Male, Middle Aged, Single-Blind Method, Critical Illness, Refeeding Syndrome

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