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

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 center dot kg(-1)center dot 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 center dot kg(-1)center dot d(-1)). Results: There were 82 infections in the hypocaloric group and 66 in the eucaloric group, with no significant difference in the mean (+/- SE) number of infections per patient (2.0 +/- 0.6 and 1.6 +/- 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 +/- 2.7 and 13.5 +/- 1.1 d, respectively; P = 0.28), mean hospital length of stay (35.2 +/- 4.9 and 31.0 +/- 2.5 d, respectively; P = 0.45), mean 0600 glucose concentration (132 2.9 and 135 +/- 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.