NUTRIREA-3
Trial question
What is the role of early calorie and protein restriction in ventilated adults with shock?
Study design
Multi-center
Open label
RCT
Population
3036 patients.
Inclusion criteria: adult patients receiving invasive mechanical ventilation and vasopressor support for shock.
Key exclusion criteria: specific nutritional needs; pregnancy; not-to-be-resuscitated order; department of corrections inmate.
Interventions
N=1521 early calorie and protein restriction (6 kcal/kg/day and 0.2-0.4 g/kg/day protein during the first 7 days in the ICU).
N=1515 standard calorie and protein targets (25 kcal/kg/day and 1.0-1.3 g/kg/day protein during the first 7 days in the ICU).
Primary outcome
Median time to readiness for intensive care unit discharge
8 days
9 days
9.0 days
6.8 days
4.5 days
2.3 days
0.0 days
Early calorie and protein
restriction
Standard calorie and protein
targets
Significant
decrease ▼
Significantly shorter median time to readiness for ICU discharge (8 days vs. 9 days; HR 0.89, 95% CI 0.82 to 0.98).
Secondary outcomes
No significant difference in all-cause mortality at day 90 (41.3% vs. 42.8%; ARD -1.5, 95% CI -5 to 2).
Conclusion
In adult patients receiving invasive mechanical ventilation and vasopressor support for shock, early calorie and protein restriction were superior to standard calorie and protein targets with respect to median time to readiness for ICU discharge.
Reference
Jean Reignier, Gaetan Plantefeve, Jean-Paul Mira et al. Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3). Lancet Respir Med. 2023 Jul;11(7):602-612.
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