No Benefit to Energy Dense Enteral Nutrition in Critically Ill Patients

TARGET Investigators, for the the ANZICS Clinical Trials Group. 

N Engl J Med 2018 Oct 

When to start enteral nutrition and how much to feed a critically ill patient is a subject of ongoing debate. Previous studies suggest that low caloric levels of enteral nutrition (i.e., trophic feeds) might be sufficient.

Investigators from New Zealand and Australia randomized nearly 4000 mechanically ventilated patients to receive either standard (1 kcal/mL) or energy-dense (1.5 kcal/mL) enteral nutrition. The target rate for both groups was 1 mL per kg ideal body weight per hour. Most patients were in the intensive care unit for nonoperative reasons; one third were obese. Median times to start enteral nutrition were 16 hours in each group. Patients received feeding for a mean 6 days and at 80% of the targeted rate. The standard group received, on average, 70% of the clinician-determined target calories; whereas the energy-dense group received 100%, as each mL delivered more calories. Liberation from ventilator, length of stay, and mortality were similar between groups. The energy-dense group had higher gastric residuals, received more promotility agents, and vomited more often — all significant differences.