Intensive Nutrition in Acute Lung Injury: A Clinical Trial (INTACT)
Open accessAbstract
Background: Despite extensive use of enteral (EN) and parenteral nutrition (PN) in intensive care unit (ICU) populations for 4 decades, evidence to support their efficacy is extremely limited. Methods : A prospective randomized trial was conducted evaluate the impact on outcomes of intensive medical nutrition therapy (IMNT; provision of >75% of estimated energy and protein needs per day via EN and adequate oral diet) from diagnosis of acute lung injury (ALI) to hospital discharge compared with standard nutrition support care (SNSC; standard EN and ad lib feeding). The primary outcome was infections; secondary outcomes included number of days on mechanical ventilation, in the ICU, and in the hospital and mortality. Results : Overall, 78 patients (40 IMNT and 38 SNSC) were recruited. No significant differences between groups for age, body mass index, disease severity, white blood cell count, glucose, C‐reactive protein, energy or protein needs occurred. The IMNT group received significantly higher percentage of estimated energy (84.7% vs 55.4%, P < .0001) and protein needs (76.1 vs 54.4%, P < .0001) per day compared with SNSC. No differences occurred in length of mechanical ventilation, hospital or ICU stay, or infections. The trial was stopped early because of significantly greater hospital mortality in IMNT vs SNSC (40% vs 16%, P = .02). Cox proportional hazards models indicated the hazard of death in the IMNT group was 5.67 times higher ( P = .001) than in the SNSC group. Conclusions : Provision of IMNT from ALI diagnosis to hospital discharge increases mortality.
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Studies (134, 138) and the meta-analysis derived from them (144, 145, 146) concluded there was no difference between normocaloric and hypocaloric diets in critically ill patients.
“These studies (134, 138) and the metaanalysis derived from them (144, 145, 146) concluded that there was no difference between normocaloric versus hypocaloric diets in critically ill patients.”
From ESPEN guideline on clinical nutrition in the intensive care unit. (2019) · cites this paper as [134]
The Results (page unavailable) report significantly higher mortality with intensive nutrition than with standard care (39% versus 16%), and the Discussion says the trial was stopped early because of that difference. Although several other outcomes did not differ, this study did not conclude that the feeding approaches were equivalent. (LLM, conf=0.88)
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Ridley, E., Davies, A., Hodgson, C., Deane, A., Bailey, M., & Cooper, D. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2017.09.026 · Cited by 24 · see citing works
Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study
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Self-citationZhang, Q., Zhou, J., Zhu, D., & Zhou, S. (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10672 · Cited by 29 · see citing works
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Early or Late Feeding after ICU Admission?
Blaser, A. R., & Berger, M. M. (2017) · Nutrients · doi:10.3390/nu9121278 · Cited by 26 · see citing works
Should enteral nutrition be started in the first week of critical illness?
Martindale, R. G., & Warren, M. M. (2015) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000146 · Cited by 26 · see citing works
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Should We Aim for Full Enteral Feeding in the First Week of Critical Illness?
McClave, S. A., Codner, P. A., Patel, J. J., Hurt, R. T., Allen, K. S., & Martindale, R. G. (2016) · Nutrition in Clinical Practice · doi:10.1177/0884533616653809 · Cited by 23 · see citing works
Major publications in the critical care pharmacotherapy literature in 2015
Wong, A., Erdman, M. J., Hammond, D. A., Holt, T., Holzhausen, J. M., Horng, M., Huang, L. L., Jarvis, J., Kram, B., Kram, S. J., et al. (2017) · American Journal of Health-System Pharmacy · doi:10.2146/ajhp160144 · Cited by 24 · see citing works
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Early Enteral Nutrition in Mechanically Ventilated Patients With COVID‐19 Infection
Farina, N., Nordbeck, S., Montgomery, M., Cordwin, L., Blair, F., Cherry‐Bukowiec, J. R., Kraft, M. D., Pleva, M. R., & Raymond, E. (2021) · Nutrition in Clinical Practice · doi:10.1002/ncp.10629 · Cited by 23 · see citing works
Wang, C.-Y., Fu, P., Huang, C.-T., Chen, C., Lee, B., & Huang, Y. (2018) · Nutrients · doi:10.3390/nu10111731 · Cited by 23 · see citing works
Is early starvation beneficial for the critically ill patient?
Marik, P. E. (2016) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000256 · Cited by 21 · see citing works
Nakanishi, N., Matsushima, S., Tatsuno, J., Liu, K., Tamura, T., Yonekura, H., Yamamoto, N., Unoki, T., Kondo, Y., & Nakamura, K. (2022) · Nutrients · doi:10.3390/nu14224849 · Cited by 21 · see citing works
Gastrointestinal dysmotility in the critically ill
Weimann, A., & Felbinger, T. W. (2016) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000300 · Cited by 21 · see citing works
A Novel Risk Score to Predict the Need for Nutrition Support After Cardiac Surgery
Ohkuma, R., Crawford, T. C., Brown, P. M., Grimm, J. C., Magruder, J. T., Kilic, A., Suarez‐Pierre, A., Snyder, S., Wood, J. D., Schneider, E. B., et al. (2017) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2017.03.013 · Cited by 21 · see citing works
Wang, X., Zhang, C., Chen, C., Guo, Y. C., Meng, X., & Kan, C. (2018) · Molecular Medicine Reports · doi:10.3892/mmr.2018.8693 · Cited by 21 · see citing works
Sartini, C., Ломиворотов, В. В., Pieri, M., Delgado, J. C. L., Redaelli, M. B., Hajjar, L. A., Pisano, A., Likhvantsev, V. V., Fominskiy, E. V., Bradic, N., et al. (2018) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2018.11.026 · Cited by 21 · see citing works
Ding, Y., Feng, Q., Chen, J., & Song, J. (2019) · Medicine · doi:10.1097/md.0000000000016029 · Cited by 21 · see citing works
High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients
Hoffer, L. J. (2018) · Nutrition in Clinical Practice · doi:10.1002/ncp.10091 · Cited by 18 · see citing works
Perioperative gastrointestinal problems in the ICU
Blaser, A. R., Starkopf, J., Moonen, P.-J., Malbrain, M. L. N. G., & Straaten, H. M. O. (2014) · Anaesthesiology Intensive Therapy · doi:10.5603/ait.a2017.0064 · Cited by 19 · see citing works
Parenteral nutrition in the critically ill
Gunst, J., & den Berghe, G. V. (2017) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000385 · Cited by 18 · see citing works
Yue, H.-Y., Peng, W. J., Zeng, J., Zhang, Y., Wang, Y., & Jiang, H. (2024) · Journal of Intensive Care · doi:10.1186/s40560-024-00717-3 · Cited by 19 · see citing works
Updates in Nutrition Support for Critically III Adult Patients
Mulherin, D. W., & Cogle, S. V. (2017) · Hospital Pharmacy · doi:10.1310/hpj5201-17 · Cited by 18 · see citing works
Saha, R., Assouline, B., Mason, G., Douiri, A., Summers, C., & Shankar‐Hari, M. (2021) · British Journal of Anaesthesia · doi:10.1016/j.bja.2021.02.027 · Cited by 18 · see citing works
Feeding During Phases of Altered Mitochondrial Activity: A Theory
McKeever, L., Bonini, M. G., & Braunschweig, C. L. (2017) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1010 · Cited by 18 · see citing works
Self-citationPelekhaty, S. L., Galvagno, S., Lantry, J., Dolly, K., Herr, D., Kon, Z., Deatrick, K., Cornachione, C. R., Scalea, T., & Menaker, J. (2020) · JPEN - Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.1602 · Cited by 15 · see citing works
Le concept du « Baby stomach » appliqué à la nutrition du patient agressé
Preiser, J., Fraipont, V., & Lheureux, O. (2019) · Nutrition Clinique et Métabolisme · doi:10.1016/j.nupar.2019.05.003 · Cited by 18 · see citing works
Chelkeba, L., Mojtahedzadeh, M., & Mekonnen, Z. (2017) · Indian Journal of Critical Care Medicine · doi:10.4103/ijccm.ijccm_453_16 · Cited by 17 · see citing works
Update on nutritional assessment and therapy in critical care
Blaser, A. R., Rice, T. W., & Deane, A. M. (2020) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000694 · Cited by 16 · see citing works
Hajimohammadebrahim‐Ketabforoush, M., Shariatpanahi, Z. V., Shariatpanahi, M. V., Shahbazi, E., & Shahbazi, S. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.708271 · Cited by 18 · see citing works
Pros and Cons of Feeding the Septic Intensive Care Unit Patient
Fremont, R. D., & Rice, T. W. (2015) · Nutrition in Clinical Practice · doi:10.1177/0884533615578457 · Cited by 17 · see citing works
Parker, E. A. D., Feinberg, T., Wappel, S. R., & Verceles, A. C. (2017) · Current Nutrition Reports · doi:10.1007/s13668-017-0196-8 · Cited by 16 · see citing works
Perspectives: on Precision Nutrition Research in Heart, Lung, and Blood Diseases and Sleep Disorders
PRATT, C. A., Brown, A. G. M., Dixit, S., Farmer, N. M., Natarajan, A. R., Boyington, J., Shi, S., Lu, Q., & Cotton, P. A. (2022) · Advances in Nutrition · doi:10.1093/advances/nmac053 · Cited by 15 · see citing works
Study protocol for the Augmented versus Routine Approach to Giving Energy Trial (TARGET)
Williams, P. J. (2018) · Critical Care and Resuscitation · doi:10.1016/s1441-2772(23)00734-2 · Cited by 15 · see citing works
Peterson, S. J., McKeever, L., Lateef, O., Freels, S. A., Fantuzzi, G., & Braunschweig, C. A. (2018) · Critical Care Medicine · doi:10.1097/ccm.0000000000003476 · Cited by 14 · see citing works
Self-citationIntensive Care Nutrition and Post–Intensive Care Recovery
Gunst, J., & den Berghe, G. V. (2018) · Critical Care Clinics · doi:10.1016/j.ccc.2018.06.004 · Cited by 14 · see citing works
Gomez‐Perez, S. L., Zhang, Y., Byrne, C. A., Wakefield, C., Geesey, T., Sclamberg, J. S., & Peterson, S. J. (2022) · Sensors · doi:10.3390/s22093357 · Cited by 15 · see citing works
Self-citationThe Impact of Higher Protein Intake in Patients with Prolonged Mechanical Ventilation
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Impact of early protein provision on the mortality of acute critically ill stroke patients
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Critical Care Nutrition: Where's the Evidence?
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Sartini, C., Ломиворотов, В. В., Pisano, A., Říha, H., Redaelli, M. B., Delgado, J. C. L., Pieri, M., Hajjar, L. A., Fominskiy, E. V., Likhvantsev, V. V., et al. (2019) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2019.03.022 · Cited by 11 · see citing works
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Enteral feeding, even when the gut does not feel very good?
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Self-citation
- Authors
- Braunschweig, C. A., Sheean, P. M., Peterson, S. J., Gomez Perez, S., Freels, S., Lateef, O., Gurka, D., & Fantuzzi, G.
- Affiliations
- University of Illinois Chicago (US)
- Loyola University Chicago (US)
- Rush University Medical Center (US)
- Corresponding author
- Braunschweig, Carol A.
- ORCID
- Venue
- Journal of Parenteral and Enteral Nutrition
- Publisher
- Wiley
- Published
- 2014-04-09
- Volume
- 39
- Issue
- 1
- Pages
- 13-20
- ISSN
- 0148-6071 (ISSN-L)
- 1941-2444
- PMC
- PMC4205213
- OpenAlex
- W1999372553
- Cited by
- 199
- References
- 43
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 15 · 2023: 9 · 2022: 14 · 2021: 25 · 2020: 9 · 2019: 24 · 2018: 27 · 2017: 29 · 2016: 19 · 2015: 11 · 2014: 2 · 2013: 1
- FWCI
- 18.94
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- Journal of Parenteral and Enteral Nutrition (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Heart, Lung, and Blood Institute (R01HL093142)
- 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
- acute lung injury, enteral nutrition, parenteral nutrition, nutritional support, in-hospital mortality, mechanical ventilation duration, infection, ICU length of stay, energy and protein requirements
- MeSH terms
- Adult, Aged, Blood Cell Count, Blood Glucose, Body Weight, C-Reactive Protein, Energy Intake, Dietary Proteins, Enteral Nutrition, Female, Humans, Intensive Care Units, Male, Middle Aged, Parenteral Nutrition, Prospective Studies, Respiration, Artificial, Body Mass Index, Proportional Hazards Models, Treatment Outcome, Hospital Mortality, APACHE, Acute Lung Injury
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