Intensive nutrition in acute lung injury: a clinical trial (INTACT).
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.
Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA braunsch@uic.edu.
Carol A
CA
Braunschweig
Loyola University, Chicago, Illinois, USA.
Patricia M
PM
Sheean
Department of Food and Nutrition, Rush University Medical Center, Chicago, Illinois, USA.
Sarah J
SJ
Peterson
Institute for Health Policy and Research, University of Illinois at Chicago, Chicago, Illinois, USA.
Sandra
S
Gomez Perez
Department of Epidemiology and Biostatitics, University of Illinois at Chicago, Chicago, Illinois, USA.
Sally
S
Freels
Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA.
Omar
O
Lateef
Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA.
David
D
Gurka
Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, Illinois, USA.
Giamila
G
Fantuzzi
D018806:APACHE; D055371:Acute Lung Injury / Q000401:mortality* / Q000628:therapy*; D000328:Adult; D000368:Aged; D001772:Blood Cell Count; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D001835:Body Weight; D002097:C-Reactive Protein / Q000378:metabolism*; D004044:Dietary Proteins / Q000008:administration & dosage; D002149:Energy Intake; D004750:Enteral Nutrition; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010288:Parenteral Nutrition; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D016896:Treatment Outcome
D001786:Blood Glucose; D004044:Dietary Proteins; D002097:C-Reactive Protein
fluids-electrolytes/acid-base; nutrition; parenteral nutrition; research and diseases