Near-target caloric intake in critically ill medical-surgical patients is associated with adverse outcomes.
BACKGROUND
The objective of this study was to determine whether caloric intake independently influences mortality and morbidity of critically ill patients.


METHODS
The study was conducted as a nested cohort study within a randomized controlled trial in a tertiary care intensive care unit (ICU). The main exposure in the study was average caloric intake/target for the first 7 ICU days. The primary outcomes were ICU and hospital mortality. Secondary outcomes included ICU-acquired infections, ventilator-associated pneumonia (VAP), duration of mechanical ventilation days, and ICU and hospital length of stay (LOS). The authors divided patients (n = 523) into 3 tertiles according to the percentage of caloric intake/target: tertile I <33.4%, tertile II 33.4%-64.6%, and tertile III >64.6%. To adjust for potentially confounding variables, the authors assessed the association between caloric intake/target and the different outcomes using multivariate logistic regression for categorical outcomes (tertile I was used as reference) and multiple linear regression for continuous outcomes.


RESULTS
Tertile III was associated with higher adjusted hospital mortality, higher risk of ICU-acquired infections, and a trend toward higher VAP rate. Increasing caloric intake was independently associated with a significant increase in duration of mechanical ventilation, ICU LOS, and hospital LOS.


CONCLUSIONS
The data demonstrate that near-target caloric intake is associated with significantly increased hospital mortality, ICU-acquired infections, mechanical ventilation duration, and ICU and hospital LOS. Further studies are needed to explore whether reducing caloric intake would improve the outcomes in critically ill patients.
Arabi
Yaseen M
YM
Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, Saudi Arabia. yaseenarabi@yahoo.com
Haddad
Samir H
SH
Tamim
Hani M
HM
Rishu
Asgar H
AH
Sakkijha
Maram H
MH
Kahoul
Salim H
SH
Britts
Riette J
RJ
D000368:Aged; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods / Q000592:standards*; D016638:Critical Illness / Q000401:mortality*; D003428:Cross Infection / Q000209:etiology*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology; D011182:Postoperative Care / Q000379:methods / Q000592:standards*; D012016:Reference Values; D012121:Respiration, Artificial / Q000706:statistics & numerical data*; D012307:Risk Factors