RCT

TARGET

Energy-Dense versus Routine Enteral Nutrition in the Critically Ill

NEJM, 2018 · Multicenter double-blind randomized clinical trial in 46 Australian and New Zealand ICUs (n=3957)

Clinical question

Does energy-dense enteral nutrition delivering higher caloric intake improve 90-day survival in mechanically ventilated ICU patients?

Population: Adults expected to receive enteral nutrition for >= 2 days in the ICU
Intervention: Energy-dense enteral nutrition formula (1.5 kcal/mL delivering 100% estimated energy target)
Comparator: Routine enteral nutrition formula (1.0 kcal/mL delivering ~70% energy target)
Primary outcome: All-cause mortality at 90 days
Result: 90-day mortality was 26.8% in the 1.5-kcal group and 25.7% in the 1.0-kcal group (relative risk 1.05; 95% CI, 0.94 to 1.16; P=0.41). Patients receiving 1.5 kcal/mL had significantly more gastrointestinal intolerance (vomiting 10.5% vs 8.6%, P=0.04) and higher insulin requirements.

What the trial found

Higher caloric delivery (100% of target) via energy-dense enteral nutrition did not improve survival and increased gastrointestinal intolerance.

Current guideline position

Supported in ESPEN and ASPEN critical care nutrition guidelines.

Clinical interpretation

Confirmed that moderate/permissive underfeeding (~70% energy target) during early critical illness is safe and avoids overfeeding complications.

Clinical Context & Relevant Topics (1)

Disease Reference

Critical Illness Nutrition & Metabolism

Phased energy and protein delivery, early enteral nutrition when safe, indirect calorimetry, refeeding prevention, feeding-intolerance troubleshooting, and individualized parenteral nutrition timing.

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