Monday, 20 July 2015

CALORIES - does it matter how we give them?

I had the great fortune of chatting to one of England's pre-eminent critical care physicians, Prof Monty Mythen in my latest podcast for the Society of Critical Care Medicine.

Monty was one of the lead authors of the CALORIES trial, released in 2014.  CALORIES randomised critically ill patients to enteral nutrition or parenteral nutrition within 36 hours of admission to the ICU and continued this for up to 5 days.

While many in critical care believe that if the enteral route is available to administer nutrition, it should be used, citing benefits in gut endothelial function and protection, and the avoidance of complications associated with TPN as possible benefits.

However, the evidence for these benefits is still limited, and there are some see TPN as beneficial by guaranteeing calorie delivery when compared with EN.  It should be noted that there is also limited evidence for this contention.

So, CALORIES sought to determine if there was, indeed, any benefit of EN or TPN early in the course of the patient's illness.

In the end, there were no differences in the primary outcome point of 30 day mortality.  While this would have surprised few, what was surprising was that there was almost no difference in calorie delivery.

To hear more about this thought provoking trial, have a listen to Monty's podcast.

You can also check out a more detailed review of CALORIES that I wrote last year