Skip to main content

A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial.

Publication ,  Journal Article
Wischmeyer, PE; Hasselmann, M; Kummerlen, C; Kozar, R; Kutsogiannis, DJ; Karvellas, CJ; Besecker, B; Evans, DK; Preiser, J-C; Gramlich, L ...
Published in: Crit Care
June 9, 2017

BACKGROUND: Nutrition guidelines recommendations differ on the use of parenteral nutrition (PN), and existing clinical trial data are inconclusive. Our recent observational data show that amounts of energy/protein received early in the intensive care unit (ICU) affect patient mortality, particularly for inadequate nutrition intake in patients with body mass indices (BMIs) of <25 or >35. Thus, we hypothesized increased nutrition delivery via supplemental PN (SPN) + enteral nutrition (EN) to underweight and obese ICU patients would improve 60-day survival and quality of life (QoL) versus usual care (EN alone). METHODS: In this multicenter, randomized, controlled pilot trial completed in 11 centers across four countries, adult ICU patients with acute respiratory failure expected to require mechanical ventilation for >72 hours and with a BMI of <25 or ≥35 were randomized to receive EN alone or SPN + EN to reach 100% of their prescribed nutrition goal for 7 days after randomization. The primary aim of this pilot trial was to achieve a 30% improvement in nutrition delivery. RESULTS: In total, 125 patients were enrolled. Over the first 7 post-randomization ICU days, patients in the SPN + EN arm had a 26% increase in delivered calories and protein, whereas patients in the EN-alone arm had a 22% increase (both p < 0.001). Surgical ICU patients received poorer EN nutrition delivery and had a significantly greater increase in calorie and protein delivery when receiving SPN versus medical ICU patients. SPN proved feasible to deliver with our prescribed protocol. In this pilot trial, no significant outcome differences were observed between groups, including no difference in infection risk. Potential, although statistically insignificant, trends of reduced hospital mortality and improved discharge functional outcomes and QoL outcomes in the SPN + EN group versus the EN-alone group were observed. CONCLUSIONS: Provision of SPN + EN significantly increased calorie/protein delivery over the first week of ICU residence versus EN alone. This was achieved with no increased infection risk. Given feasibility and consistent encouraging trends in hospital mortality, QoL, and functional endpoints, a full-scale trial of SPN powered to assess these clinical outcome endpoints in high-nutritional-risk ICU patients is indicated-potentially focusing on the more poorly EN-fed surgical ICU setting. TRIAL REGISTRATION: NCT01206166.

Duke Scholars

Altmetric Attention Stats
Dimensions Citation Stats

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

June 9, 2017

Volume

21

Issue

1

Start / End Page

142

Location

England

Related Subject Headings

  • Time Factors
  • Thinness
  • Pilot Projects
  • Parenteral Nutrition
  • Overweight
  • Nutritional Status
  • Middle Aged
  • Male
  • Length of Stay
  • Intensive Care Units
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wischmeyer, P. E., Hasselmann, M., Kummerlen, C., Kozar, R., Kutsogiannis, D. J., Karvellas, C. J., … Heyland, D. K. (2017). A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Crit Care, 21(1), 142. https://doi.org/10.1186/s13054-017-1736-8
Wischmeyer, Paul E., Michel Hasselmann, Christine Kummerlen, Rosemary Kozar, Demetrios James Kutsogiannis, Constantine J. Karvellas, Beth Besecker, et al. “A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial.Crit Care 21, no. 1 (June 9, 2017): 142. https://doi.org/10.1186/s13054-017-1736-8.
Wischmeyer PE, Hasselmann M, Kummerlen C, Kozar R, Kutsogiannis DJ, Karvellas CJ, et al. A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Crit Care. 2017 Jun 9;21(1):142.
Wischmeyer, Paul E., et al. “A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial.Crit Care, vol. 21, no. 1, June 2017, p. 142. Pubmed, doi:10.1186/s13054-017-1736-8.
Wischmeyer PE, Hasselmann M, Kummerlen C, Kozar R, Kutsogiannis DJ, Karvellas CJ, Besecker B, Evans DK, Preiser J-C, Gramlich L, Jeejeebhoy K, Dhaliwal R, Jiang X, Day AG, Heyland DK. A randomized trial of supplemental parenteral nutrition in underweight and overweight critically ill patients: the TOP-UP pilot trial. Crit Care. 2017 Jun 9;21(1):142.

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

June 9, 2017

Volume

21

Issue

1

Start / End Page

142

Location

England

Related Subject Headings

  • Time Factors
  • Thinness
  • Pilot Projects
  • Parenteral Nutrition
  • Overweight
  • Nutritional Status
  • Middle Aged
  • Male
  • Length of Stay
  • Intensive Care Units