Intensive Care Medicine

, Volume 37, Issue 4, pp 601–609

The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients

  • Pierre Singer
  • Ronit Anbar
  • Jonathan Cohen
  • Haim Shapiro
  • Michal Shalita-Chesner
  • Shaul Lev
  • Elad Grozovski
  • Miryam Theilla
  • Sigal Frishman
  • Zecharia Madar
Original

DOI: 10.1007/s00134-011-2146-z

Cite this article as:
Singer, P., Anbar, R., Cohen, J. et al. Intensive Care Med (2011) 37: 601. doi:10.1007/s00134-011-2146-z

Abstract

Purpose

To determine whether nutritional support guided by repeated measurements of resting energy requirements improves the outcome of critically ill patients.

Methods

This was a prospective, randomized, single-center, pilot clinical trial conducted in an adult general intensive care (ICU) unit. The study population comprised mechanically ventilated patients (n = 130) expected to stay in ICU more than 3 days. Patients were randomized to receive enteral nutrition (EN) with an energy target determined either (1) by repeated indirect calorimetry measurements (study group, n = 56), or (2) according to 25 kcal/kg/day (control group, n = 56). EN was supplemented with parenteral nutrition when required.

Results

The primary outcome was hospital mortality. Measured pre-study resting energy expenditure (REE) was similar in both groups (1,976 ± 468 vs. 1,838 ± 468 kcal, p = 0.6). Patients in the study group had a higher mean energy (2,086 ± 460 vs. 1,480 ± 356 kcal/day, p = 0.01) and protein intake (76 ± 16 vs. 53 ± 16 g/day, p = 0.01). There was a trend towards an improved hospital mortality in the intention to treat group (21/65 patients, 32.3% vs. 31/65 patients, 47.7%, p = 0.058) whereas length of ventilation (16.1 ± 14.7 vs. 10.5 ± 8.3 days, p = 0.03) and ICU stay (17.2 ± 14.6 vs. 11.7 ± 8.4, p = 0.04) were increased.

Conclusions

In this single-center pilot study a bundle comprising actively supervised nutritional intervention and providing near target energy requirements based on repeated energy measurements was achievable in a general ICU and may be associated with lower hospital mortality.

Keywords

Nutritional support Critically ill Indirect calorimetry Energy balance 

Supplementary material

134_2011_2146_MOESM1_ESM.doc (234 kb)
Supplementary material 1 (DOC 233 kb)

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Pierre Singer
    • 1
    • 2
    • 3
  • Ronit Anbar
    • 2
    • 4
    • 5
  • Jonathan Cohen
    • 1
    • 3
  • Haim Shapiro
    • 2
  • Michal Shalita-Chesner
    • 2
  • Shaul Lev
    • 1
    • 3
  • Elad Grozovski
    • 1
    • 3
  • Miryam Theilla
    • 2
  • Sigal Frishman
    • 5
  • Zecharia Madar
    • 4
  1. 1.Department of General Intensive CareRabin Medical CenterPetah TikvaIsrael
  2. 2.Institute for Nutrition ResearchRabin Medical CenterPetah TikvaIsrael
  3. 3.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.School of Nutritional Sciences, The Robert H. Smith Faculty of Agricultural, Food and Environmental Quality SciencesHebrew UniversityJerusalemIsrael
  5. 5.Nutrition UnitRabin Medical CenterPetah TikvaIsrael

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