title: The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients.
abstract: OBJECTIVE
  To determine whether nutritional support guided by repeated measurements of resting energy requirements improves the outcome of critically ill patients.
  
  
  METHODS
  This was a prospective, randomized, single-center, pilot clinical trial conducted in an adult general intensive care (ICU) unit. The study population comprised mechanically ventilated patients (n = 130) expected to stay in ICU more than 3 days. Patients were randomized to receive enteral nutrition (EN) with an energy target determined either (1) by repeated indirect calorimetry measurements (study group, n = 56), or (2) according to 25 kcal/kg/day (control group, n = 56). EN was supplemented with parenteral nutrition when required.
  
  
  RESULTS
  The primary outcome was hospital mortality. Measured pre-study resting energy expenditure (REE) was similar in both groups (1,976 ± 468 vs. 1,838 ± 468 kcal, p = 0.6). Patients in the study group had a higher mean energy (2,086 ± 460 vs. 1,480 ± 356 kcal/day, p = 0.01) and protein intake (76 ± 16 vs. 53 ± 16 g/day, p = 0.01). There was a trend towards an improved hospital mortality in the intention to treat group (21/65 patients, 32.3% vs. 31/65 patients, 47.7%, p = 0.058) whereas length of ventilation (16.1 ± 14.7 vs. 10.5 ± 8.3 days, p = 0.03) and ICU stay (17.2 ± 14.6 vs. 11.7 ± 8.4, p = 0.04) were increased.
  
  
  CONCLUSIONS
  In this single-center pilot study a bundle comprising actively supervised nutritional intervention and providing near target energy requirements based on repeated energy measurements was achievable in a general ICU and may be associated with lower hospital mortality.
authors.affiliation: Department of General Intensive Care, Rabin Medical Center, Campus Beilinson, 49100, Petah Tikva, Israel. psinger@clalit.org.il
authors.forename: Pierre
authors.initials: P
authors.lastname: Singer
authors.forename: Ronit
authors.initials: R
authors.lastname: Anbar
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.forename: Haim
authors.initials: H
authors.lastname: Shapiro
authors.forename: Michal
authors.initials: M
authors.lastname: Shalita-Chesner
authors.forename: Shaul
authors.initials: S
authors.lastname: Lev
authors.forename: Elad
authors.initials: E
authors.lastname: Grozovski
authors.forename: Miryam
authors.initials: M
authors.lastname: Theilla
authors.forename: Sigal
authors.initials: S
authors.lastname: Frishman
authors.forename: Zecharia
authors.initials: Z
authors.lastname: Madar
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000379:methods*; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial; D016896:Treatment Outcome