title: Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized controlled trial.
abstract: BACKGROUND
  Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection.
  
  
  OBJECTIVE
  This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support.
  
  
  METHODS
  Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25-30 kcal · kg(-1) · d(-1) (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g · kg(-1) · d(-1)).
  
  
  RESULTS
  There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (± SE) number of infections per patient (2.0 ± 0.6 and 1.6 ± 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 ± 2.7 and 13.5 ± 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 ± 4.9 and 31.0 ± 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 ± 2.9 and 135 ± 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism.
  
  
  CONCLUSIONS
  Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive.
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Charles
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Robin T
authors.initials: RT
authors.lastname: Petroze
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Rosemarie
authors.initials: R
authors.lastname: Metzger
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Tjasa
authors.initials: T
authors.lastname: Hranjec
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Laura H
authors.initials: LH
authors.lastname: Rosenberger
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Lin M
authors.initials: LM
authors.lastname: Riccio
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Matthew D
authors.initials: MD
authors.lastname: McLeod
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Guidry
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: George J
authors.initials: GJ
authors.lastname: Stukenborg
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Brian R
authors.initials: BR
authors.lastname: Swenson
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Kate F
authors.initials: KF
authors.lastname: Willcutts
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Kelly B
authors.initials: KB
authors.lastname: O'Donnell
authors.affiliation: From the Department of Surgery, University of Virginia Health System, Charlottesville, VA (EJC, RTP, RM, TH, LHR, LMR, MDM, CAG, BRS, KFW, KBO, and RGS), and the Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA (GJS).
authors.forename: Robert G
authors.initials: RG
authors.lastname: Sawyer
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D015992:Body Mass Index; D001835:Body Weight; D016638:Critical Illness / Q000628:therapy; D003428:Cross Infection / Q000517:prevention & control*; D023381:Endpoint Determination; D002149:Energy Intake; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D018529:Nutritional Support / Q000379:methods*
chemical_list: D001786:Blood Glucose