A Randomized Noninferiority Trial to Compare Enteral to Parenteral Phosphate Replacement on Biochemistry, Waste, and Environmental Impact and Healthcare Cost in Critically Ill Patients With Mild to Moderate Hypophosphatemia*
Primary result · Serum phosphate concentrationResult — go to the resultDifference 0.07 mmol/L 95% CI −0.02 to 0.17Authors' conclusion
Enteral phosphate replacement in ICU is noninferior to IV replacement at a margin of 0.2 mmol/L but leads to a substantial reduction in cost and waste.
Study context
- Population
- ICU patients with serum phosphate 0.3–0.75 mmol/L (mild to moderate hypophosphatemia)modified ITT cohort
- Participants
- 131 patients
- Comparison
- Enteral vs IV phosphate replacement
- Primary endpoint
- Serum phosphate (noninferiority margin 0.2 mmol/L)
- Follow-up
- 24 hours
Methodological detailsprospective, parallel group, noninferiority, single centre, Single centre, 42-bed trauma, medical and surgical ICUs, April 20, 2022 to July 1, 2022
- Prospective
- Parallel group
- Noninferiority
- Single centre
- Single centre, 42-bed trauma, medical and surgical ICUs, April 20, 2022 to July 1, 2022
Primary result
Serum phosphate concentration
Difference
0.07 mmol/L
95% CI −0.02 to 0.17
By group
Enteral vs IV
difference 0.07 mmol/L (95% CI −0.02 to 0.17)
As reported in the abstract
Secondary outcomes
Mean, g
| Outcome | Enteral | IV | Difference (g) (95% CI) | |
|---|---|---|---|---|
| Weight of waste | 7.7 (SD 8.3 g) | 217 (SD 169 g) | 209 (168–250) | |
| −1000100200300Difference, g (linear scale) |
| Outcome | Enteral | IV | Difference (95% CI) |
|---|---|---|---|
| Cost per patientTen-fold less with enteral · mean $ | 3.7 (SD $4.0) | 37.7 (SD $31.4) | $34.0 ($26.3-$41.7) |
| CO2 emissions for comparable phosphate replacement | 14.2 g | 843 g of CO2 equivalents |
- Solvent IV fluid received
- 408 · mean · SD 372 · mL
- CO2 emissions for comparable phosphate replacement: enteral 2 g vs IV 20 mmol potassium dihydrogen phosphate
CO2 emissions for comparable phosphate replacement
- CO2 emissions 60-fold less with enteral
Original publication
A Randomized Noninferiority Trial to Compare Enteral to Parenteral Phosphate Replacement on Biochemistry, Waste, and Environmental Impact and Healthcare Cost in Critically Ill Patients With Mild to Moderate Hypophosphatemia*. Crit Care Med. Published 25 March 2024. doi:10.
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