Hypocaloric compared with eucaloric nutritional support and its effect on infection rates in a surgical intensive care unit: a randomized

Background: Proper caloric intake goals in critically ill surgical patients are unclear. It is possible that overnutrition can lead to hyperglycemia and an increased risk of infection. Objective: This study was conducted to determine whether surgical infection outcomes in the intensive care unit (ICU) could be improved with the use of hypocaloric nutritional support. Design: Eighty-three critically ill patients were randomly allocated to receive either the standard calculated daily caloric requirement of 25–30 kcal $ kg –1 $ d –1 (eucaloric) or 50% of that value (hypocaloric) via enteral tube feeds or parenteral nutrition, with an equal protein allocation in each group (1.5 g $ kg –1 $ d –1 ). Results: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (6SE) number of infections per patient (2.0 6 0.6 and 1.6 6 0.2, respectively; P = 0.50), percentage of patients acquiring infection [70.7% (29 of 41) and 76.2% (32 of 42), respectively; P = 0.57], mean ICU length of stay (16.7 6 2.7 and 13.5 6 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 6 4.9 and 31.0 6 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 6 2.9 and 135 6 3.1 mg/dL, respectively; P = 0.63), or number of mortalities [3 (7.3%) and 4 (9.5%), respectively; P = 0.72]. Further analyses revealed no differences when analyzed by sex, admission diagnosis, site of infection, or causative organism. Conclusions: Among critically ill surgical patients, caloric provision across a wide acceptable range does not appear to be associated with major outcomes, including infectious complications. The optimum target for caloric provision remains elusive. Am J Clin Nutr 2014;100:1337–43.