Macro partitioning
The delayed recovery associated with early nutrition is driven primarily by protein/amino acid intake rather than glucose intake.
Current guidelines recommending high protein intake early in critical illness may need revision. This analysis suggests that high protein/amino acid doses, rather than glucose, are the primary drivers of delayed recovery in early parenteral nutrition. Clinicians should be cautious about high-protein parenteral formulas in the first week of ICU stay.
The amount of proteins/amino acids rather than of glucose appeared to explain delayed recovery with early feeding.
Why this rating
Observational analysis within the RCT; while robust, it is a post-hoc secondary analysis of macronutrient ratios.
Source
Role of Disease and Macronutrient Dose in the Randomized Controlled EPaNIC Trial
Michaël P. Casaer et al. · American Journal of Respiratory and Critical Care Medicine · 2012
DOI 10.1164/rccm.201206-0999oc
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- Higher cumulative energy intake (caloric dose) during the first week of ICU stay is inversely associated with recovery speed; the lowest caloric doses are associated with the fastest recovery.Strong
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