Abstract
Background and aims
The optimal energy delivery for mechanically ventilated patients is controversial, particularly during the first week of ICU admission. This study aimed to investigate the association between different caloric adequacy and 28-day mortality in a cohort of critically ill adults on mechanical ventilation.
Methods
This is a secondary analysis of a multicenter, cluster-randomized controlled trial. Eligible patients were divided into four quartiles (Q1-Q4) according to caloric adequacy calculated by the actual average daily energy delivery during the first seven days of ICU stay divided by energy requirement as a percentage. Cox proportional hazards models were used to examine the impact of different quartiles of caloric adequacy on 28-day mortality in the whole cohort and subgroups with different nutritional risk status at enrollment.
Results
A total of 1587 patients were included in this study, with an overall 28-day mortality of 15.8%. The average caloric adequacy was 26.3 ± 11.9% (Q1), 52.5 ± 5.5% (Q2), 71.7 ± 6.4% (Q3), 107.0 ± 22.2% (Q4), respectively (p < 0.001 among quartiles). Compared with Q1, Q3 was associated with lower mortality in the unadjusted model (hazard ratio [HR] = 0.536; 95% confidence interval [CI], 0.375–0.767; P = 0.001) and adjusted model (adjusted HR = 0.508; 95% CI, 0.339–0.761; P = 0.001). This association remained valid in the subgroup of high nutritional risk patients (unadjusted HR = 0.387; 95% CI, 0.238–0.627; P < 0.001 and adjusted HR = 0.369; 95% CI, 0.216–0.630; P < 0.001, respectively), but not in those with low risk.
Conclusions
Energy delivery near the 70% energy requirements in the first week of ICU stay was associated with reduced 28-day mortality among mechanically ventilated critically ill patients, especially in patients with high nutrition risk at admission.
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Data availability
The data sets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request and approval from the ethics committee.
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Acknowledgements
The authors would like to acknowledge all the patients and health staff who participated in the original trial.
Funding
This research was funded by the National Natural Science Foundation of China (82070665) and the Major Program of Military Logistics Research Plan (ALB18J001).
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JJL, LK, WQL and ZYJ contributed to the conceptualization and design of the study; LTW, YL and ZXZ contributed to the acquisition and analysis of data; LTW, JZ, GL, BY, HZ, LG and ZHT contributed to the interpretation of data; LTW drafted the manuscript; LK and ZYJ provided critical edits to the manuscript. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work. All authors have read and agreed to the published version of the manuscript.
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Ethical approval
This study was a secondary analysis of a cluster-randomized controlled trial (ISRCTN registry: ISRCTN12233792), which was approved by the ethics committee of Jinling Hospital (2017NZKY-010-01).
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Wang, L., Long, Y., Zhang, Z. et al. Association of energy delivery with short-term survival in mechanically ventilated critically ill adult patients: a secondary analysis of the NEED trial. Eur J Clin Nutr 78, 257–263 (2024). https://doi.org/10.1038/s41430-023-01369-6
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DOI: https://doi.org/10.1038/s41430-023-01369-6