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Association of energy delivery with short-term survival in mechanically ventilated critically ill adult patients: a secondary analysis of the NEED trial

Abstract

Background and aims

The optimal energy delivery for mechanically ventilated patients is controversial, particularly during the first week of ICU admission. This study aimed to investigate the association between different caloric adequacy and 28-day mortality in a cohort of critically ill adults on mechanical ventilation.

Methods

This is a secondary analysis of a multicenter, cluster-randomized controlled trial. Eligible patients were divided into four quartiles (Q1-Q4) according to caloric adequacy calculated by the actual average daily energy delivery during the first seven days of ICU stay divided by energy requirement as a percentage. Cox proportional hazards models were used to examine the impact of different quartiles of caloric adequacy on 28-day mortality in the whole cohort and subgroups with different nutritional risk status at enrollment.

Results

A total of 1587 patients were included in this study, with an overall 28-day mortality of 15.8%. The average caloric adequacy was 26.3 ± 11.9% (Q1), 52.5 ± 5.5% (Q2), 71.7 ± 6.4% (Q3), 107.0 ± 22.2% (Q4), respectively (p < 0.001 among quartiles). Compared with Q1, Q3 was associated with lower mortality in the unadjusted model (hazard ratio [HR] = 0.536; 95% confidence interval [CI], 0.375–0.767; P = 0.001) and adjusted model (adjusted HR = 0.508; 95% CI, 0.339–0.761; P = 0.001). This association remained valid in the subgroup of high nutritional risk patients (unadjusted HR = 0.387; 95% CI, 0.238–0.627; P < 0.001 and adjusted HR = 0.369; 95% CI, 0.216–0.630; P < 0.001, respectively), but not in those with low risk.

Conclusions

Energy delivery near the 70% energy requirements in the first week of ICU stay was associated with reduced 28-day mortality among mechanically ventilated critically ill patients, especially in patients with high nutrition risk at admission.

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Fig. 1: Flowchart of patient selection.
Fig. 2: Kaplan-Meier survival curves for the association of energy adequacy with primary outcome.
Fig. 3: Dose-effect association between increasing energy adequacy and 28-day mortality.

Data availability

The data sets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request and approval from the ethics committee.

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Acknowledgements

The authors would like to acknowledge all the patients and health staff who participated in the original trial.

Funding

This research was funded by the National Natural Science Foundation of China (82070665) and the Major Program of Military Logistics Research Plan (ALB18J001).

Author information

Author notes

  1. These authors contributed equally: Lanting Wang, Yi Long.

Authors and Affiliations

  1. Department of Critical Care Medicine, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China

    Lanting Wang, Zixiong Zhang, Jiajia Lin, Jing Zhou, Gang Li, Bo Ye, He Zhang, Lin Gao, Zhihui Tong, Weiqin Li & Lu Ke

  2. Department of Critical Care Medicine, Chongqing University Cancer Hospital, Chongqing, China

    Yi Long & Zhengying Jiang

  3. National Institute of Healthcare Data Science, Nanjing University, Nanjing, China

    Weiqin Li & Lu Ke

  4. Sir Run Run Shaw Hospital, Hangzhou, China

    Feng Guo

  5. Liverpool School of Tropical Medicine, Liverpool, UK

    Tao Chen

  6. BenQ Medical Center, Nanjing, China

    Juan Xing

  7. First People’s Hospital of Foshan, Foshan, China

    Lixin Zhou

  8. First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China

    Jiandong Lin

  9. Suzhou Municipal Hospital, Suzhou, China

    Jun Liu

  10. North China University of Science and Technology Affiliated Hospital, Tangshan, China

    Yafeng Liang

  11. Chengdu University of Traditional Chinese Medicine Affiliated Hospital, Chengdu, China

    Peiyang Gao

  12. Luoyang Central Hospital, Luoyang, China

    Junli Sun

  13. Changzhou No. 2 People’s Hospital, Changzhou, China

    Wenming Liu

  14. The Second Affiliated Hospital of Harbin Medical University, Harbin, China

    Zhenyu Yang

  15. Zibo Central Hospital, Zibo, China

    Rumin Zhang

  16. The Third Xiangya Hospital of Central South University, Changsha, China

    Wei Xing

  17. The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China

    An Zhang

  18. First People’s Hospital of Kunming, Kunming, China

    Zhigang Zhou

  19. Linyi City People Hospital, Linyi, China

    Tingfa Zhou

  20. Tangshan Gongren Hospital, Tangshan, China

    Yang Liu

  21. Hebei Medical University Second Affiliated Hospital, Hebei, China

    Fei Tong

  22. Wuxi People’s Hospital, Wuxi, China

    Qiuhui Wang

  23. The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China

    Rongqing Sun

Authors

  1. Lanting Wang
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  2. Yi Long
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  3. Zixiong Zhang
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  4. Jiajia Lin
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  5. Jing Zhou
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  6. Gang Li
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  7. Bo Ye
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  8. He Zhang
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  9. Lin Gao
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  10. Zhihui Tong
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  11. Weiqin Li
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  12. Lu Ke
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  13. Zhengying Jiang
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Consortia

the Chinese Critical Care Nutrition Trials Group (CCCNTG)

  • Lu Ke
  • , Jiajia Lin
  • , Zhihui Tong
  • , Weiqin Li
  • , Lanting Wang
  • , Yi Long
  • , Zhengying Jiang
  • , Feng Guo
  • , Tao Chen
  • , Juan Xing
  • , Lixin Zhou
  • , Jiandong Lin
  • , Jun Liu
  • , Yafeng Liang
  • , Peiyang Gao
  • , Junli Sun
  • , Wenming Liu
  • , Zhenyu Yang
  • , Rumin Zhang
  • , Wei Xing
  • , An Zhang
  • , Zhigang Zhou
  • , Tingfa Zhou
  • , Yang Liu
  • , Fei Tong
  • , Qiuhui Wang
  •  & Rongqing Sun

Contributions

JJL, LK, WQL and ZYJ contributed to the conceptualization and design of the study; LTW, YL and ZXZ contributed to the acquisition and analysis of data; LTW, JZ, GL, BY, HZ, LG and ZHT contributed to the interpretation of data; LTW drafted the manuscript; LK and ZYJ provided critical edits to the manuscript. All authors agree to be fully accountable for ensuring the integrity and accuracy of the work. All authors have read and agreed to the published version of the manuscript.

Corresponding authors

Correspondence to
Lu Ke or Zhengying Jiang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

This study was a secondary analysis of a cluster-randomized controlled trial (ISRCTN registry: ISRCTN12233792), which was approved by the ethics committee of Jinling Hospital (2017NZKY-010-01).

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Cite this article

Wang, L., Long, Y., Zhang, Z. et al. Association of energy delivery with short-term survival in mechanically ventilated critically ill adult patients: a secondary analysis of the NEED trial.
Eur J Clin Nutr (2023). https://doi.org/10.1038/s41430-023-01369-6

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  • Received: 28 April 2023

  • Revised: 01 November 2023

  • Accepted: 09 November 2023

  • Published: 25 November 2023

  • DOI: https://doi.org/10.1038/s41430-023-01369-6

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