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Cited by 351Clinical Nutrition and GastroenterologyNosocomial Infections in ICURespiratory Support and Mechanisms

Randomized trial of initial trophic versus full-energy enteral nutrition in mechanically ventilated patients with acute respiratory failure

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Rice, Todd W., Mogan, Susan, Hays, Margaret A., Bernard, Gordon R., Jensen, Gordon L., Wheeler, Arthur P.·2011·Critical Care Medicine
DOI 10.1097/ccm.0b013e31820a905aPMC PMC3102124
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Abstract

OBJECTIVE: Enteral nutrition is provided to mechanically ventilated patients who cannot eat normally, yet the amount of support needed is unknown. We conducted this randomized, open-label study to test the hypothesis that initial low-volume (i.e., trophic) enteral nutrition would decrease episodes of gastrointestinal intolerance/complications and improve outcomes as compared to initial full-energy enteral nutrition in patients with acute respiratory failure. DESIGN: Randomized, open-label study. PATIENTS: A total of 200 patients with acute respiratory failure expected to require mechanical ventilation for at least 72 hrs. INTERVENTIONS: Patients were randomized to receive either initial trophic (10 mL/hr) or full-energy enteral nutrition for the initial 6 days of ventilation. MEASUREMENTS AND MAIN RESULTS: The primary outcome measure was ventilator-free days to day 28. Baseline characteristics were similar between the 98 patients randomized to trophic and the 102 patients randomized to full-energy nutrition. At enrollment, patients had a mean Acute Physiology and Chronic Health Evaluation II score of 26.9 and a PaO2/FiO2 ratio of 182 and 38% were in shock. Both groups received similar durations of enteral nutrition (5.5 vs. 5.1 days; p = .51). The trophic group received an average of 15.8% ± 11% of goal calories daily through day 6 compared to 74.8% ± 38.5% (p < .001) for the full-energy group. Both groups had a median of 23.0 ventilator-free days (p = .90) and a median of 21.0 intensive-care-unit-free days (p = .64). Mortality to hospital discharge was 22.4% for the trophic group vs. 19.6% for the full-energy group (p = .62). In the first 6 days, the trophic group had trends for less diarrhea (19% vs. 24% of feeding days; p = .08) and significantly fewer episodes of elevated gastric residual volumes (2% vs. 8% of feeding days; p < .001). CONCLUSION: Initial trophic enteral nutrition resulted in clinical outcomes in mechanically ventilated patients with acute respiratory failure similar to those of early full-energy enteral nutrition but with fewer episodes of gastrointestinal intolerance.

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  • Marik and Hooper (132) reported lower hospital mortality for permissive underfeeding compared with standard normocaloric feeding.

    “In another meta-analysis, Marik and Hooper (132) reported a lower hospital mortality for permissive underfeeding as compared with standard normocaloric feeding.”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [132]

    In Results > Clinical Outcomes, hospital mortality was 22.4% with initial trophic feeding versus 19.6% with full-energy feeding (P=0.62), rather than lower with underfeeding. The Discussion describes the groups' clinical outcomes as similar. The cited paper is a randomized trial by Rice et al., not a Marik and Hooper meta-analysis. (LLM, conf=0.90)

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  • A recent meta-analysis revealed that the effect of different energy intake levels on clinical outcome as suggested by observational studies is probably overestimated.

    “A recent meta-analysis revealed that the effect of different energy intake levels on clinical outcome as suggested by observational studies is probably over estimated (132).”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [132]

    The Discussion (page not provided) contrasts observational findings linking higher energy intake to better outcomes with this randomized trial’s finding of similar outcomes at different intake levels. That supports the possibility that observational estimates overstate the benefit, but the cited paper is a single trial, not the meta-analysis the claim describes. (LLM, conf=0.85)

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Cited by

Sorted by citations

Authors
Rice, T. W., Mogan, S., Hays, M. A., Bernard, G. R., Jensen, G. L., & Wheeler, A. P.
Affiliations
  • Vanderbilt University (US)
  • Pennsylvania State University (US)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-05
Volume
39
Issue
5
Pages
967-974
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0b013e31820a905a
PMC
PMC3102124
OpenAlex
W2049292458
Cited by
351
References
1
Citations by year
2026: 6 · 2025: 6 · 2024: 18 · 2023: 13 · 2022: 16 · 2021: 18 · 2020: 27 · 2019: 23 · 2018: 24 · 2017: 35 · 2016: 33 · 2015: 41 · 2014: 35 · 2013: 29 · 2012: 19
FWCI
26.89
Type
journal article
Language
en
Open access
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Heart, Lung, and Blood Institute (R34HL105869, K23-HL81431, K23HL081431)
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK058404)
  • National Center for Research Resources (UL1RR024975)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Nosocomial Infections in ICU
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
Keywords
enteral nutrition, trophic feeding, mechanical ventilation, acute respiratory failure, gastrointestinal intolerance, gastric residual volume, diarrhea, ventilator-free days, mortality
MeSH terms
Academic Medical Centers, Acute Disease, Adult, Aged, Critical Care, Enteral Nutrition, Female, Follow-Up Studies, Humans, Intensive Care Units, Male, Middle Aged, Nutritional Requirements, Parenteral Nutrition, Respiration, Artificial, Respiratory Insufficiency, Risk Factors, Time Factors, Survival Rate, Treatment Outcome, Hospital Mortality, Statistics, Nonparametric, Kaplan-Meier Estimate

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