RCT | Low-calorie, low-protein feeding improves recovery time in ventilated adults with shock

Summary: The NUTRIREA-3 study aimed to determine the optimal calorie and protein intakes during the acute phase of severe critical illness. The study was a randomized, controlled, multicenter, open-label, parallel-group trial conducted in 61 French intensive care units (ICUs) involving 3044 adults receiving invasive mechanical ventilation and vasopressor support for shock. During the first seven ICU days, participants were randomly assigned to early nutrition with either low or standard calorie and protein targets. The primary endpoints were time to readiness for ICU discharge and day 90 all-cause mortality, while key secondary outcomes included secondary infections, gastrointestinal events, and liver dysfunction.

The study found that early calorie and protein restriction did not decrease mortality. However, it was associated with faster recovery and fewer complications compared to standard calorie and protein targets. The low-calorie, low-protein group had a shorter median time to readiness for ICU discharge and lower proportions of patients with vomiting, diarrhea, bowel ischemia, and liver dysfunction. The proportions of patients with secondary infections did not differ significantly between the two groups.

In conclusion, the NUTRIREA-3 study provides evidence that patients may benefit from restricted calorie and protein intakes during the acute phase of critical illness, as it expedites recovery and reduces the risk of complications.

Article: Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3) – The Lancet Respiratory Medicine (free registration required)

Commentary on Twitter

NEW Research—Early calorie & protein restriction did not decrease mortality but was associated w/ faster recovery & fewer complications than standard intake targets

NUTRIREA-3 from Prof Jean Reignier & co https://t.co/VCS72qxLPD

Being presented @ISICEM today! #ISICEM23 pic.twitter.com/TpoJnwHP8P

— The Lancet Respiratory Medicine (@LancetRespirMed) March 21, 2023