Table 3.
Summary of seminal RCTs exploring the impact of energy provision on clinical outcomes.
| RCTs | Population | Duration | Intervention | Control | Primary outcome | Long-term follow-up |
|---|---|---|---|---|---|---|
| EPaNIC trial (2011)[58] | 4640 adults with NRS ≥ 3 | Up to day 16* | Late PN (≥day 8) | Early PN (within 48 h) | ↑ Time to discharge alive from ICU | Yes |
| EDEN trial (2012)[35] | 1000 adults within 48 h of ALI onset requiring MV | Up to day 12* | Trophic EN (Day 1–6) | Full EN | ↔ VFDs to day 28 | Yes |
| Early PN trial (2013)[59] | 1372 adults with contraindications to early EN | NR; target achieved by study Day 3 | Early PN (Day 1) | Standard care PN | ↔ Day-60 mortality | Yes |
| PermiT trial (2015)[57] | 894 medical, surgical or trauma ICU adult patients | Up to 14 days† |
Permissive EN |
Standard EN | ↔ Day 90 mortality | No |
| TARGET trial (2018)[60] | 3957 adult ICU patients undergoing MV | Up to 28 days‡ | 1.5 kcal EN | 1.0 kcal EN | ↔ 90-day mortality | Yes |
RCTs were identified via a Medline (Ovid) search combining the terms “critical* ill* or Intensive Care Unit or ICU” with “energy or nutrition delivery”. Articles were included if they enrolled ≥ 500 patients and were published in quartile 1 medicine journals such as The New England Journal of Medicine and Journal of the American Medical Association.
↑: statistically significant increase in outcome observed in the intervention compared to control; ↔: No statistically significant difference reported between the intervention and control.
ALI: Acute lung injury; EPaNIC: Early Parenteral Nutrition completing Enteral Nutrition in Adult Critically Ill Patients; EDEN: Early vs. Delayed Enteral Feeding to Treat People with Acute Lung Injury or Acute Respiratory Distress Syndrome; EN: Enteral nutrition; ICU: Intensive care unit; IQR: Interquartile range; MV: Mechanical ventilation; NR: Not reported; NRS: Nutrition risk screening; PN: Parenteral nutrition; PermiT: Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients; RCTs: Randomized controlled trials; TARGET: Early PN and the Augmented vs. Routine Approach to Giving Energy; VFD: Ventilator-free day.
⁎ Actual study duration: NR.
† mean 9 ± 5 days (intervention) and 9 ± 4 days (control).
‡ median 6 (IQR: 3–11) days in both groups.