• Assessment
    What level of energy intake (or what caloric delivery) is associated with improvements in mortality?
    • Conclusion

      Actual energy intake of 9 to 18 kcal per kg may be associated with decreased mortality in nonobese critically ill medical patients, based on a single positive quality prospective cohort study of 187 patients.  It is important to emphasize that the calorie intake associated with decreased mortality in this study was actual intake and not goal, so that setting goal calorie level in the range of 9-18 kcal per kg will likely result in actual intake that is less than this range.  Three other smaller, possibly underpowered studies failed to show any association between energy intake and mortality in other ICU populations.

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What level of energy intake (or what caloric delivery) is associated with improvements in rate of infectious complications?
    • Conclusion

      There is fair evidence that infectious complications are increased in critically ill patients who have very low caloric intake. In one positive quality prospective cohort study, patients who received <25% of AACP energy goal had increased infection rate.

    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What level of energy intake (or what caloric delivery) is associated with improvements in length of hospital stay?
    • Conclusion
      There is fair evidence that energy intake in the ICU does not affect hospital or ICU length of stay.
       
       
                       
                
       
       
       
       
       
       
       
       
       
       
       
    • Grade: II
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What level of energy intake (or what caloric delivery) is associated with improvements in days on mechanical ventilation?
    • Conclusion

       

       

      Energy intake may have impact on days on mechanical ventilation.  Within the first 10 days in the ICU, actual delivery of < 21 nonprotein kcals per kg by PN is associated with fewer days on mechanical ventilation.  Actual delivery of 9-18 kcals per kg by EN is also associated with fewer days on mechanical ventilation.  Further studies are needed.

       

    • Grade: III
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.
    What level of energy intake (or what caloric delivery) is associated with improvements in cost of medical care?
    • Conclusion

      To date, adequately powered studies have not been conducted to demonstrate that level of energy intake is associated with improvements in cost of medical care.

    • Grade: V
      • Grade I means there is Good/Strong evidence supporting the statement;
      • Grade II is Fair;
      • Grade III is Limited/Weak;
      • Grade IV is Expert Opinion Only;
      • Grade V is Not Assignable.
      • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
      • Moderate (B) means we are moderately confident in the effect estimate;
      • Low (C) means our confidence in the effect estimate is limited;
      • Very Low (D) means we have very little confidence in the effect estimate.
      • Ungraded means a grade is not assignable.