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Cited by 293Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsSepsis Diagnosis and Treatment

Optimal amount of calories for critically ill patients: Depends on how you slice the cake!*

Heyland, Daren K., Cahill, Naomi, Day, Andrew G.·2011·Critical Care Medicine
DOI 10.1097/ccm.0b013e318226641d
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Abstract

OBJECTIVE: The optimal amount of calories required by critically ill patients continues to be controversial. The objective of this study is to examine the relationship between the amount of calories administered and mortality. DESIGN: Prospective, multi-institutional audit. SETTING: Three hundred fifty-two intensive care units from 33 countries. PATIENTS: A total of 7,872 mechanically ventilated, critically ill patients who remained in the intensive care unit for at least 96 hrs. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated the association between the amount of calories received and 60-day hospital mortality using various sample restriction and statistical adjustment techniques and demonstrate the influence of the analytic approach on the results. In the initial unadjusted analysis, we observe a significant association between increased caloric intake and increased mortality (odds ratio 1.28; 95% confidence interval 1.12-1.48 for patients receiving more than two-thirds of their caloric prescription vs. those receiving less than one-third of their prescription). Excluding days after permanent progression to oral intake attenuated the estimates of harm (unadjusted analysis: odds ratio 1.04; 95% confidence interval 0.90-1.20). Restricting the analysis to patients with at least 4 days in the intensive care unit before progression to oral intake and excluding days of observation after progression to oral intake resulted in a significant benefit to increased caloric intake (unadjusted odds ratio 0.73; 95% confidence interval 0.63-0.85). When further adjusting for both evaluable days and other important covariates, patients who received more than two-thirds of their caloric prescription are much less likely to die than those receiving less than one-third of their prescription (odds ratio 0.67; 95% confidence interval 0.56-0.79; p < .0001). When treated as a continuous variable, the overall association between the percent of the caloric prescription received and mortality is highly statistically significant with increasing calories associated with decreasing mortality (p < .0001). CONCLUSIONS: The estimated association between the amount of calories and mortality is significantly influenced by the statistical methodology used. The most appropriate available analyses suggest that attempting to meet caloric targets may be associated with improved clinical outcomes in critically ill patients.

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Crossref · 10.1097/ccm.0b013e318226641d

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  • The Braunschweig study (136) found an increase in mortality in patients receiving calories close to the prescribed recommended energy intake, with likely refeeding syndrome as explanation.

    “The Braunschweig study (136) found an increase in mortality in the group of patients receiving calories close to the prescribed recommended energy intake, without an explanation of the cause of death, except a likely refeeding syndrome (147).”

    From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [147]

  • Large observational series have observed that the optimal calorie load associated with the best survival is around 80% of predicted energy needs, whereas others suggested no relation between intake and outcome or better outcome with lower energy intakes.

    “Large observational series including hundreds to thousands of patients have observed that the optimal calorie load associated with the best survival is around 80% of predicted energy needs [53], whereas others suggested no relation between intake and outcome or better outcome with lower energy intakes [54].”

    From ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit (2023) · cites this paper as [53]

  • In a large prospective study, only 0.8% of more than 8000 cases collected underwent IC measurement.

    “As shown in a large prospective study, only 0.8% of the more than 8000 cases collected underwent IC measurement [28].”

    From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [28]

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Authors
Heyland, D. K., Cahill, N., & Day, A. G.
Affiliations
  • Kingston General Hospital (CA)
  • Queen's University (CA)
ORCID
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2011-12
Volume
39
Issue
12
Pages
2619-2626
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/ccm.0b013e318226641d
OpenAlex
W2019218952
Cited by
293
References
24
Citations by year
2026: 7 · 2025: 14 · 2024: 14 · 2023: 14 · 2022: 19 · 2021: 30 · 2020: 20 · 2019: 24 · 2018: 32 · 2017: 27 · 2016: 22 · 2015: 24 · 2014: 23 · 2013: 14 · 2012: 6
FWCI
13.01
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Health Research Board
  • Canadian Institutes of Health Research
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 › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
energy intake, critically ill patients, mechanical ventilation, 60-day mortality, nutritional support, sample selection bias, statistical adjustment, oral intake, intensive care unit
MeSH terms
Energy Intake, Critical Care, Female, Humans, Intensive Care Units, Length of Stay, Male, Middle Aged, Prospective Studies, Regression Analysis, Odds Ratio, Hospital Mortality, Nutritional Support

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