TARGET (energy-dense formulation)
Trial question
What is the role of energy-dense formulation for enteral delivery of nutrition in patients undergoing mechanical ventilation?
Study design
Multi-center
Double blinded
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 3957
3957 patients (1464 female, 2493 male).
Inclusion criteria: adult patients undergoing mechanical ventilation in ICUs.
Key exclusion criteria: treating clinician considered the trial enteral nutrition formula or the rate of delivery to be clinically contraindicated or inevitable death.
Interventions
N=1971 energy dense (1.5 kcal/mL enteral nutrition for up to 28 days).
N=1986 routine (1.0 kcal/mL enteral nutrition for up to 28 days).
Primary outcome
Rate of all-cause mortality within 90 days
26.8%
25.7%
26.8 %
20.1 %
13.4 %
6.7 %
0.0 %
Energy
dense
Routine
No significant
difference ↔
No significant difference in the rate of all-cause mortality within 90 days (26.8% vs. 25.7%; RR 1.05, 95% CI 0.94 to 1.16).
Secondary outcomes
No significant difference in the rate of death by day 28 (22.9% vs. 23%; RR 1, 95% CI 0.89 to 1.12).
No significant difference in receipt of vasopressor support (81.1% vs. 81.4%; RR 1, 95% CI 0.97 to 1.03).
No significant difference in receipt of RRT (18.9% vs. 18.5%; RR 1.02, 95% CI 0.9 to 1.16).
Safety outcomes
No significant differences in adverse events, serious adverse events.
Significant differences in regurgitation or vomiting (18.9% vs. 15.7%), largest gastric residual volume (250 ml vs. 180 ml), increased daily blood glucose levels (225.2 mg/dL vs. 212.6 mg/dL).
Conclusion
In adult patients undergoing mechanical ventilation in ICUs, energy dense was not superior to routine with respect to the rate of all-cause mortality within 90 days.
Reference
TARGET Investigators, for the ANZICS Clinical Trials Group, Marianne Chapman et al. Energy-Dense versus Routine Enteral Nutrition in the Critically Ill. N Engl J Med. 2018 Nov 8;379(19):1823-1834.
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