O023 - THE EFFICACY OF CALORIMETRY-BASED NUTRITIONAL SUPPORT VERSUS RECOMMENDED DIETARY INTAKE-BASED NUTRITIONAL SUPPORT IN THE SUCCESSFUL WEANING OF POST ICU CHRONICALLY VENTILATED PATIENTS: A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL.

Linked sessions

O023

THE EFFICACY OF CALORIMETRY-BASED NUTRITIONAL SUPPORT VERSUS RECOMMENDED DIETARY INTAKE-BASED NUTRITIONAL SUPPORT IN THE SUCCESSFUL WEANING OF POST ICU CHRONICALLY VENTILATED PATIENTS: A DOUBLE-BLIND RANDOMIZED CONTROLLED TRIAL.

M. Fradkin1,2, M. Elyashiv3, M. Brik4, N. Agai5, M. G. Kait6, L. Bornstein6, P. Singer7,*, R. Dankner4,5,8

1Schoenbrun Academic Nursing School, Sourasky Medical Center, 2PhD candidate, Tel Aviv University, 3Intubation Unit, 4Reuth Research and Development Institute, Reuth Tel-Aviv Rehabilitation Medical Center, Tel-Aviv, 5Research Center for Public Health, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan, 6Nutrition, Reuth Tel-Aviv Rehabilitation Medical Center, 7Faculty of Health Sciences and Medicine, Tel Aviv University, 8Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Health Sciences and Medicine, Tel-Aviv, Israel

 

Rationale: Optimal nutrition care is crucial for successful weaning. Indirect calorimetry (IC) based nutritional plan may be preferable than predicted equations (PE) for weaning from prolong Mechanical ventilation (PMV) (>21 days).

Methods: PMV patients admitted to a rehabilitation center for weaning were randomized to receive either IC-based feeding (intervention) or PE-based feeding (control). Primary outcomes included weaning success rates, defined as achieving >7 consecutive days of spontaneous breathing. Secondary outcomes included 12-month survival rates. IRB agreement was obtained. Kaplan Meir curves were plotted to compare weaning rates and 1-year survival according to study arm. We used Cox regression model for the association between excess caloric difference (nutritional plan minus IC) provided to all patients in the study and weaning success, adjusting for study arm, age, and sex.

Results: 211 patients were enrolled (111 intervention, 100 control). The 2 groups were comparable in terms of demographics, clinical, and ventilation characteristics. Weaning success rates were 58% vs. 50% in the intervention vs. the control arm, respectively (p=0.65). Patients in the IC arm received in mean 350 kcal/d less than in the predictive equation-based group. Each 50-calorie reduction in the difference between prescribed nutrition and measured calorimetry was associated with 2% greater weaning success (HR=1.02, 95%CI: 1.00-1.05, p=0.02). One-year mortality rates were 48% and 56% in the intervention and control arms, respectively (p=0.29).

Image:



 

Conclusion: Indirect calorimetry-based nutritional plan showed promising trends toward improved weaning success and reduced weaning time in PMV patients. A larger multicenter study is warranted to definitively establish the efficacy of this approach.

Disclosure of Interest: None declared