Low versus standard calorie and protein feeding in ventilated adults with shock: a randomised, controlled, multicentre, open-label, parallel-group trial (NUTRIREA-3)
Authors' conclusion
Compared with standard calorie and protein targets, early calorie and protein restriction did not decrease mortality but was associated with faster recovery and fewer complications.
Study context
- Population
- Adults (≥18 years) receiving invasive mechanical ventilation and vasopressor support for shock, 61 French intensive care units (ICUs)randomised
- Participants
- 3,044 adults
- Comparison
- Low vs Standard
- Lown = 1,521
- Standardn = 1,515reference
- Primary endpoint
- Two primary endpoints: time to readiness for ICU discharge and day 90 all-cause mortality
Methodological detailspragmatic, multicentre, open-label, parallel-group
- Pragmatic
- Multicentre
- Open-label
- Parallel-group
Primary result
As reported in the abstract
Day 90 all-cause mortality; time to readiness for ICU discharge (co-primary)
Low vs StandardAbsolute difference (95% CI)P value
Day 90 mortality
−1.5%(−5.0 to 2.0)
P = 0.41Low vs StandardHazard ratio (95% CI)P value
Time to readiness for ICU discharge
1.12(1.02–1.22)
P = 0.015Secondary outcomes
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Gastrointestinal events and liver dysfunctionLow vs Standard · vomiting | 0.77 (0.67–0.89) | P < 0.001 | |
| Gastrointestinal events and liver dysfunctionLow vs Standard · diarrhoea | 0.83 (0.73–0.94) | P = 0.004 | |
| Gastrointestinal events and liver dysfunctionLow vs Standard · bowel ischaemia | 0.50 (0.26–0.95) | P = 0.030 | |
| Gastrointestinal events and liver dysfunctionLow vs Standard · liver dysfunction | 0.92 (0.86–0.99) | P = 0.032 | |
| 0.20.5125Hazard ratio (log scale) |
Secondary infections
- Proportions with secondary infections did not differ between the groups
- HR 0.85, 0.71 to 1.01; p=0.06
Safety
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Gastrointestinal events and liver dysfunctionLow vs Standard · vomiting | 0.77 (0.67–0.89) | P < 0.001 | |
| Gastrointestinal events and liver dysfunctionLow vs Standard · diarrhoea | 0.83 (0.73–0.94) | P = 0.004 | |
| Gastrointestinal events and liver dysfunctionLow vs Standard · bowel ischaemia | 0.50 (0.26–0.95) | P = 0.030 | |
| Gastrointestinal events and liver dysfunctionLow vs Standard · liver dysfunction | 0.92 (0.86–0.99) | P = 0.032 | |
| 0.20.5125Hazard ratio (log scale) |
Original publication
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. Published 20 March 2023. doi:10.
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