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United For Clinical Nutrition EuroPN Survey: A study aiming to characterize the current use of clinical nutrition in European ICUs

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#1 Relevance and
             Rationale

Adequate nutrition is essential to support the recovery of hospitalized patients, particularly those with critical illness.1,2

What is adequate clinical nutrition in the critically ill patient?

The adequate amount of energy and protein remains a matter of debate in critically ill patients. There is a high need to better understand the current nutrition practice and associated outcomes for optimal critical care nutrition.3-5

Controversies about the positive impact of clinical nutrition on outcomes related to critical illness and post-discharge are still ongoing.3-20

The generated data may contribute to the development of targeted nutritional interventions as well as subsequent clinical trials.

#2 Objectives

The EuroPN Survey

The largest longitudinal real-world study on clinical nutrition in critically ill adult patients in the ICU beyond 5 days

  • To assess calorie and protein balance in critically ill adult patients over a period of 5 up to 15 days after admission
  • To explore the association between nutritional balance and clinical outcomes up to 90 days

Study
Design21

Approximately 1200 patients were enrolled
Around 100 intensive care units (ICUs) participating in 11 countries
Patients in the ICU beyond 5 days
Data were collected from admission until post-discharge, up to 90 days

Results are expected
to be published end of 2021

  1. Stoppe C, van Gassel R, Jonckheer J, et al. First international meeting of early career investigators: Current opportunities, challenges and horizon in critical care nutrition research, Clinical Nutrition ESPEN 40,2020,92-100.
  2. Puthucheary ZA, Rawal J, McPhail M, et al. Acute Skeletal Muscle Wasting in Critical Illness. JAMA. 2013,310(15):1591-1600.
  3. Bendavid I, Zusman O, Kagan I, et al. Early Administration of Protein in Critically Ill Patients: A Retrospective Cohort Study. Nutrients. 2019,11(1).
  4. Looijaard WGPM, Dekker IM, Beishuizen A, et al. Early high protein intake and mortality in critically ill ICU patients with low skeletal muscle area and -density. Clinical nutrition (Edinburgh, Scotland). 2019,S0261-5614(19)33067-5.
  5. Heyland DK, Weijs PJM, Coss-Bu JA, et al. Protein Delivery in the Intensive Care Unit: Optimal or Suboptimal. American Society for Parenteral and Enteral Nutrition, 2017 Apr,32(1_suppl):58S-71S.
  6. Reignier J, Boisrame-Helms J, Brisard L, et al. Enteral versus parenteral early nutrition in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group study (NUTRIREA-2). Lancet. 2018,391(10116):133-43.
  7. Singer P, Anbar R, Cohen J, et al. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011,37(4):601-9.
  8. Singer P, De Waele E, Sanchez C, et al. TICACOS international: A multi-center, randomized, prospective controlled study comparing tight calorie control versus Liberal calorie administration study. Clin Nutr. 2021 Feb,40(2):380-387.
  9. Petros S, Horbach M, Seidel F, et al. Hypocaloric vs Normocaloric Nutrition in Critically Ill Patients: A Prospective Randomized Pilot Trial. JPEN Journal of parenteral and enteral nutrition. 2016,40(2):242-9.
  10. Zusman O, Theilla M, Cohen J, et al. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care. 2016,20(1):367.
  11. Wischmeyer PE, Hasselmann M, Kummerlen C, et al. A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Crit Care. 2017,21(1):142.
  12. Casaer MP, Mesotten D, Hermans G, et al. Early versus late parenteral nutrition in critically ill adults. N Engl J Med. 2011,365(6):506-17.
  13. Berger MM, Pantet O, Jacquelin-Ravel N, et al. Supplemental parenteral nutrition improves immunity with unchanged carbohydrate and protein metabolism in critically ill patients: The SPN2 randomized tracer study. Clinical nutrition. 2019,38(5):2408-16.
  14. Compher C, Chittams J, Sammarco T, et al. Greater Protein and Energy Intake May Be Associated With Improved Mortality in Higher Risk Critically Ill Patients: A Multicenter, Multinational Observational Study. Crit Care Med. 2017,45(2):156-63.
  15. Compher C, Chittams J, Sammarco T, et al. Greater Nutrient Intake Is Associated With Lower Mortality in Western and Eastern Critically Ill Patients With Low BMI: A Multicenter, Multinational Observational Study. JPEN Journal of parenteral and enteral nutrition. 2019,43(1):63-9.
  16. Heidegger CP, Berger MM, Graf S, et al. Optimisation of energy provision with supplemental parentera nutrition in critically ill patients: a randomised controlled clinical trial. Lancet. 2013,381(9864):385-93.
  17. Weijs PJM, Mogensen KM, Rawn JD, Christopher KB. Protein Intake, Nutritional Status and Outcomes in ICU Survivors: A Single Center Cohort Study. J Clin Med. 2019,8(1):43.
  18. Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, et al. Permissive Underfeeding or Standard Enteral Feeding in Critically Ill Adults. N Engl J Med. 2015,372(25):2398-408.
  19. Arabi YM, Aldawood AS, Al-Dorzi HM, et al. Permissive Underfeeding or Standard Enteral Feeding in High- and Low-Nutritional-Risk Critically Ill Adults. Post Hoc Analysis of the PermiT Trial. Am J Respir Crit Care Med. 2017,195(5):652-62.
  20. Allingstrup MJ, Kondrup J, Wiis J, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017,43(11):1637-47.
  21. Hiesmayr M, Csomos A, Dams K, Elke G, Hartl W, Huet O, Krzych LJ, Kuechenhoff H, Matejovic M, Puthucheary ZA, Rooyackers O, Tetamo R, Tjäder I, Vaquerizo C. Protocol for a prospective cohort study on the use of clinical nutrition and assessment of long-term clinical and functional outcomes in critically ill adult patients. Clin Nutr ESPEN. 2021 Jun;43:104-110. doi: 10.1016/j.clnesp.2021.01.048. Epub 2021 Feb 12. PMID: 34024501.

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