title: Impact of the reduction of the recommended energy target in the ICU on protein delivery and clinical outcomes.
abstract: Energy targets are a matter of debate for intensive care (ICU) patients. As the guidelines have evolved, energy targets have been reduced, while the protein intake objectives have increased. The impact of these changes remains largely unknown. This quality study aimed at investigating the clinical impact of these changes in patients with an ICU stay >3 days.
  
  
  
  Observational cohort study over two 3 months periods (A, B), with distinct prevailing nutrition recommendations in patients admitted consecutively to a multidisciplinary ICU. Inclusion criterion: ICU stay >3 days. Recorded variables: severity scores, energy target and delivery, protein delivery, feeding route, length of stay (ICU, hospital) and hospital outcome. Data as mean, SD and IQR.
  
  
  
  The analysis included 389 patients, and 3920 observation days. Except for patient age (A versus B: 57.8 and 62.3 years; p = 0.010) and NRS (4.3 vs 3.9 respectively p = 0.002), the cohorts were similar. Compared to A, the mean prescribed energy target decreased by 125 kcal (1947 kcal/d vs. 1822 kcal*day-1respectively), resulting in lower energy delivery (1353 kcal*day-1vs. 1238 kcal*day-1; p < 0.0001), and reduced protein delivery (81 g*day-1vs. 65 g*day-1: p < 0.0001). These differences were associated in survivors with prolonged mechanical ventilation (5.0 days vs. 6.7 days; p = 0.004), extended ICU stay (8.5 vs. 9.9 days; p = 0.0036), and longer hospital stay (23.4 vs. 26.4 days respectively; p = 0.028). Mortality was unchanged.
  
  
  
  A linear reduction in energy target recommendation without changing the feed composition led to an unplanned and significant reduction in protein delivery, which was associated with a prolonged duration of ventilation and an extended hospital stay.
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, University Hospital CHUV, Lausanne, Switzerland. Electronic address: Mette.Berger@chuv.ch.
authors.forename: M M
authors.initials: MM
authors.lastname: Berger
authors.affiliation: Nutrition and Dietetics Department, School of Health Professions - Geneva, University of Applied Sciences Western Switzerland, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Soguel
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, University Hospital CHUV, Lausanne, Switzerland; Service of Endocrinology, Diabetes and Metabolism, University Hospital, Lausanne, Switzerland.
authors.forename: M
authors.initials: M
authors.lastname: Charrière
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: B
authors.initials: B
authors.lastname: Thériault
authors.affiliation: Service of Endocrinology, Diabetes and Metabolism, University Hospital, Lausanne, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Pralong
authors.affiliation: Service of Adult Intensive Care Medicine and Burns, University Hospital CHUV, Lausanne, Switzerland.
authors.forename: M D
authors.initials: MD
authors.lastname: Schaller
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D016638:Critical Illness / Q000628:therapy; D004044:Dietary Proteins / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D018673:Nutrition Policy; D009751:Nutritional Requirements; D009752:Nutritional Status; D064167:Recommended Dietary Allowances; D012121:Respiration, Artificial; D016896:Treatment Outcome
chemical_list: D004044:Dietary Proteins
keywords: Critical care; Malnutrition; Monitoring; Outcome; Protein requirements