Despite significant study, nutrition support in critically ill patients remains somewhat enigmatic. Tailoring support to account for individual patient variations in pre-hospital nutrition as well as metabolism of different disease states falls largely to individual physician preferences. Subsequently, clinical practice guidelines have been established to provide a framework for patient selection, timing and route of administration, and strategies to optimize delivery and monitoring of nutrition support. However, there are no published data that actually validate the standard daily caloric intake target (25-30 kcal/kg/day) outlined in the aforementioned guidelines. In fact, recent investigation demonstrates improved outcomes in patients who receive less than 65% of recommended daily caloric intake. Additional merit for hypocaloric feeding is garnered from studies in critically ill obese patients where hypocaloric, high-protein nutritional support can achieve positive nitrogen balances and positively influence length of ICU stay. Conversely, hypercaloric nutrition, or overfeeding is associated with hyperglycemia and accumulation of fat mass. Hyperglycemia itself contributes to increased infection and mortality. Logically, this data indicates that hypocaloric nutrition should result in less hyperglycemia and subsequently reduce the incidence of infection and decrease mortality. In light of this data, the purpose of this project is to prospectively determine differences in outcomes (glycemic control and rate of infection) between critically ill patients randomized to be fed 100% of standard daily caloric targets (eucaloric) versus 50% of standard daily caloric targets (hypocaloric) while maintaining a positive nitrogen balance. All adult surgical and trauma patients admitted to the University of Virginia surgical trauma intensive care unit (STICU) who meet criteria for nutrition support and study eligibility will be randomized to either eucaloric, 25-30 kcal/kg/day, or hypocaloric, 12.5-15 kcal/kg/day, feedings. It is hypothesized that hypocaloric nutrition support will lead to improvement in glycemic control, decreased rate of infection, and overall decreased mortality compared to eucaloric nutrition support in critically ill patients. Improving outcomes for all patients is an important goal of health care research. In the future, data from this pilot study may serve as a platform on which further prospective study can firmly establish caloric targets that ultimately lead to superior outcomes for our most critically ill patients. ? ? ?
