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120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

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Page 1: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

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Page 2: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

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This article was published on October 22, 2018, at NEJM.org.

Page 3: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

2003�&/2009�.),�307<0?)-

307<0?;@>6:(ESPEN)

�(ASPEN/SCCM)

285ACCPGB

��19=4@���

20-25kcal/kg/day 25-30kcal/kg/day � *(

���� ENDPN(�������)Enteral Nutrition

AENB! ��

24�"��ICU�$�

24C28�"��ICU�$�

24C48�"��

Parenteral NutritionAPNB! ��

EN'��,�2���+!

EN'��,�+7��#+! ��(*%

Page 4: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

$�KZX^`XcZX^`Xc ESPENg2018 ASPEN/SCCMg2016 CCPGg2015

��Y_b[d

20-25kcal/day���L%"K70%W

.<I;3�%�6=S80-100%J 3

25-30kcal/kg/dayARDS,MV≧72�5gtrophic/fullHESGP 8a]\>9;g%"K80%or

20ml/kg/day(PN)

8a]\>�;gUnderfeeding

ARDSg5�5Ltrophic

��'/ ENhPN(*+�����)

EN4���ICU�7�48�5��

ICU�7�24e48�5��

ICU�7�24e48�5��

PN4���EN>115G%"3J�2@I;�J�)#�JVBF(�

CD@:EN 3K�&FWANF-OF=S

8a]\�gf�%�6 8a]\9+EN�gICU���0Q=J

ENG%"J�2@I;g7-10�%�6

�)#�JRT>EN 3K�&FWANF-OF=S(� 8a]\9?UM��J4�W!,

Page 5: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

!�

!�UXZW\��#K#139LUXZW\&17PQO

�I@��CRAHT�@!�(2B)EN]&1UXZW\K1/4-�or500kcal/day(2D)

PN:�'IB��.2 .0$:T��CRAHT�@!�(1A)

EN8�"#%*8����+J24"9��;

4@FO48"9��J��8�T!�(1B)DEB;�(������/JL��NG =RAHT�@!�(2C)

PN8�"#6) �J�$:>I<�/G#139GEN>20ml/h����G?SMV[Y\5,+KPNLBI<AHT�@!�(2B)

Page 6: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

� EN��������� ��������

Page 7: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

VS.

EN,���342���4%�

EN,���347���'4%�

1"&5�#�4EN5726;=><?��$,�!092-91/��4(48�&��4)PN5��:��

Crit Nutr 2009;28:387-400

�*�(��,�.3+��38)1"&��5Hypocarolic enteral nutrition6 2-9

Crit Care Med 2009;37:1757-61

Page 8: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

ESPEN vs. ASPEN/SCCM EPaNIC trial

*Design+ Randomised controlled, Prospective, Multicenter*Patients+ ICU0� -)�('�1��NRS≧31��44640�5*Intervention/Control+ICU� �48�&��0PN��%�"(Early-initiation")ICU� �7�2PN3��-/,"(Late-initiation")*Outcome+Primary:ICU���&Secondary:�� ���)�#$���&)ICU���&)���!��&/.

Page 9: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

ICU����#Late-Initiation�� �"����

��������������

�%$Late-Ini,a,on�� �"����

���#��� �!�

Page 10: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

EPaNIC trial����⇓

����overfeeding�� �����PN�� ��→2018/1/23�JC���

Page 11: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

(Design)<X< factorial, Randomised controlled(Patients)18���.���+6.1mmol/L(110mg/dl)��1���%��1ICU �240�(Intervention/Control)��386960%-70%(permissive underfeeding�)→59.0&16.1%

90%-100%(target feeding�)→71.4&22.8%�����4.4-6.1mmol/L:IIT�;/10-11.1mmol/L(CIT�)�"2!44795(PU+IIT,PU+CIT,TG+IIT,TG+CIT)0�,- *(Outcome)Primary=28����Secondary:ICU����'�$�#'180����'������#

Am J Clin Nutr 2011;93:569-77

Page 12: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

����Permissive underfeeding��������

Primary outcome�� ����������

Page 13: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

90-100%����������Underfeeding(60%-70%)��� !

• ������� � �60%-70%(permissive underfeeding�)→59.0�16.1%90%-100%(target feeding�)→71.4�22.8%

• � �������� ��

Page 14: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

,Design- Randomised, open-lavel, Multiple-center,Patients- ALI��48�(��1+������.�#/501000�2 ,Intervention/Control-�400 kcal/�+�$'225%+ 6�(��(Trophic-feeding�)��;25kcal/kg/�→��';�1300 kcal/�+�$'280%(Full-feeding�),Outcome-Primary:28��312����*!�((VFDs)Secondary;�$6897:�&�+60����+")4ICU free�(+�%���

Page 15: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

VFD����������

60����ICU free�

��� � ���������

Page 16: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

EDEN trial⇓

Trophic feeding (400kcal/�)�Full feeding (���80%)�������

• �������80% �������

Page 17: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Design! Two-center, Randomised controlled Patients! ICU��3��&����(+-/536$��)60%���� Intervention/Control!20-30ml/h&EN ����3��*&251064&���SPN�94��#,��('-+"PN��728 kcal/kg/day8EN�9%)**EN.��(20 kcal/kg/day) Outcome!Primary:8��#,28��*&)����

SPN(supplemental PN) trial

Lancet 2013;381:385-93

Page 18: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

��������SPN�������

Page 19: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

SPN trial⇓

�� "#!$�������� ��������%3���&�overfeeding����4����underfeeding�����������'

Page 20: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

*Design+ Randomised controlled, pragmatic, seven-center, unblined*Patients+ ICU���48�%��0� �',$/-3�� �*Intervention/Control+��4657140-60%(Permissive under feeding�) →46%��4657170-1008(Standard Enteral feeding�) → 71%!���#2��.(1.2-1.5g/kg/day)*Outcome+Primary:90����Secondary9�)1���(SOFA score(ICU free�%(�&�%(�"�(�K"��

PermiT trial

N Engl J Med 2015;372:2398-408

Page 21: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

90����'���#� �$

�����&���'Permissive underfeeding�#

� %��"!

������ICU����������

���#� �$

Page 22: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

PermiT trial⇓

����$��!����EDEN���!���(�� �!��� �

EN�"�� "��%'&)#��

Page 23: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• RCT=Meta-analysis• 2015�5�?:=-�• �����:����$!A)67ICU�'A�.;62

EN:=Underfeeding;Full feedingA�/67-�• MEDLINE2EMBASE2SCOPUS2CENTRALA"39�%• 58=-�22432�'A�.• Underfeeding&(16-72%);Full feeding&(71-93%):��A�/

60��� 2ICU� �12����$!�12��#� 2($,�0• CDBFGE*�:>UnderfeedingA5@<28=BFGE<�49�+

moderate feeding(46%-72%)2trophic feeding(16%-25%)

Nutr Hosp 2017;39(1):19-29

Page 24: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Trophic feeding�'*�����+���($

Moderate feeding�'*��Full-feeding�,-

���#��)�"&%

ICU��� !� ���� !������!�����+���($

Underfeeding��'*�����+���($

Page 25: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

PermissiveUnderfeeding[IIT

EDEN SPN Permi T

Design

[Patient

2<2,RCT

BS≧110mg/dl

ICUFENI��240�

Open label RCT

ALI*(≦48h

�����/%1000�

Two-center RCT

ICU3�,ENkcal≦,!I60%

153�

Unblined RCT

ICU�:≦48h

EN9� 1��894�

Interventions Under feeding

,!PVTZ60~70%

Trophic feeding

400kcal/day or

�48I25%

SPN

4�,?N,!8HGOM>PN�&

Under feeding

,!PVTZ40~60%

Control Full feeding

,!PVTZ90~100%

Full feeding

25kcal/kg/day

EN

DIKKEN�8Standard feeding

,!PVTZ70 ~100%

Outcome :"�$Underfeeding0F�=

�����freeY60�"�$Y

ICU freeY��(*(���GB

:��(I��@SPN0F�=

"�$J���GB

90�"�Y��(.���GB2��)#J

UF0F�=

Problem

Limitation,!PVTZH6BE=G=,�L�G=QXSU�G=;- �

Full feeding@,!H6BE=G=(80%),

3+8@'GO;- �

QXSU�G= ;- ��7,!6�FAC,

RWZ�5I 1�

Page 26: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

PermissiveUnderfeedingBIIT

EDEN SPN Permi T

ProblemLimitation

� 7=;A/��'+".",�2�."8?:<�."����

Full feeding$� /��'+"."(80%),���$�.4

����

8?:<�." ������� �,%),9>A��0��

&530���@limitation6��' Moderate feeding-full feeding,outcome/�"$

!4#��(4*1Pilot study6��

Page 27: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

1Design2 Randomised controled, prospective, multicenter, double-blined, parallel-group1Patients22���EN?�)4=7��3>=��� �"�9��ICU�'112�1Intervention/Control21.5kcal/ml9EN?��4=&1.0kcal/ml9EN?��4=&1ml/kg(IBW)/h?!�810�,��/max100ml/h<6/( 7%#:�+8*�/1Outcome2Primary:EN9�09@BAC��+(kcal/day)SecondaryD$@BAC(EN+PN+59�).�09EN7$@BAC/IBW.ICU���;-�,.��� �"��,.���

Page 28: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• �56��

• ���7�

• APACHE��23�

• �����nonoperative

• DM ��23%��

• BMI�27����

• IBW��67kg

• ��"$%#&�1900kcal/day�(���� !��)

Page 29: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• "%$'�1.5kcal/ml���

• ���������

• EN�����

• � ��total����

• �� �����������

• !&#$&���������1.0kcal/ml������

Page 30: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

�����,EN������/kg/day���� �����⇒1.5kcal/ml�� 1.5kcal vs 1.0kcalEN�����1832kcal vs 1259kcaEN����/kg/day:27.3�7.4 vs 19.0�6.0kcal ���������1.5kcal�89%�

A:ENkcal/day B:ENkcal/kg/day C:ENkcal/day-���kcal D:EN+PN+glu ivkcal/day

Page 31: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

� �����ICU��������

ICU'��������#���$

���&$��28����90��������

1.5kcal/ml�%������#�"!

Page 32: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Pilot study⇓

1.5kcal/ml�EN�����1.0kcal/ml�EN��50%������ ������Survival and functional outcome�

���������

Page 33: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

����N��

���� ��

Page 34: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

PICOP ICU������� ���������

18������

I Energy-dense(1.5kcal/ml)1ml/kg(IBW)/h

C Routine(1.okcal/ml)1ml/kg(IBW)/h

O 90���������

Page 35: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Methods Trial design• ,.&*��������

• #/%',-"�)+/$/,.(�46�ICU

• 2016�6���2017�11������

• ANZIC(Australian and New Zealand Intensive Care Society)�� ��

•��������!� �� ��

Page 36: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Methods Trial design• NPONP79��R�BE⇒���<M1#>X`VK18>6!�'K�5JL;�CI?

•�&�K+-$= RFresenius Kabi DeutschlandNP��⇒Fresenius Kabi DeutschlandK�0,A�'�J�'R4�C\S`Z[WT

•�'K��>0DQ@K%�>X`VK*�H���K(3>Monash��J�)C]_YU`^J�FG?Q@K ��K"⇒6!2:���K.,OA/FE

Page 37: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Methods Patient populationPatient Inclusion1. ICU"��� �&18���

2. ���'������

3. ����(�%&��&�$�% 12����

4. ICU!48����#�������� �'&

Page 38: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Methods Patient populationExclusion criteria1. >@,IK_LZ�Y,IaE�PT12*F��>C

2. A��M1ml/kg(IBW)/hYEN:.a;�V 'PQ��(1��GY�B"=)

3. A��\,I�M5�W,I38M�BV 'PQ��

4. ��Y�HU0�MDN^`WLV��M 'PJ#?[QZ% 2�/a&S�6�M<-9W38a+[WL��

5. (�7X]RTJ90)�X0�M�$O`_��

6. 15b��Y!"4

7. C�XTARGET studyX��

Page 39: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• AB?@�,0��%�(���2:"9;=0'<��1&<.9)

• ��3��*�-<��43/.��)$!�);�> <

• �* ;==7�

• ;=3+=7routine nutrition> (

• �> <814�#*��,3'or��,.��6���*�����5�"> (

Figure S1

Page 40: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Method nutrition�!�

• Energy –dense group⇒1.5kcal/ml" Fresubin Energy Fiber Tube Feed• Routine group⇒1.0kcal/ml" Fresubin 1000 Complete Tube Feed

����*����

• � IBW;5080.91(��cm-152.4)kg• IBW;45.580.91(��cm-152.4)kg

• Energy-dense2675'routine2675*�$9:9)(.,#permuted block randomization/��

• ���-�&+Web-based randomization system/��• �-�&*�)+�� /��%"24� 0143��

Page 41: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Energy-dense Routine

Calorie 1.5kcal/ml 1kcal/ml

Fat 58g/L 27g/L

Carbohydrate 180g/L 125g/L

Protein 56g/L 55g/L

Fiber 15g/L 20g/L

Salt 2.5g/L 3.8g/L

Water 78ml/100ml 83ml/100ml

Page 42: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

���� ����������⇒Double blind����

Page 43: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

•�J�9� (B5J/I8C&)�6D��L3�

•" E1ml/kg(IBW)/h

•�63��48�4��C0<K:AL��

• END" ��MTRVL!GK:AL'��;?7B7⇒H;+$;?7>��E=D��H,2

• OverfeedingDRPNL��5C<K>G��01E100ml/hF@

• EN���#D.D��I/�D��#E-GB7

•*%�E180mg/dl��COUQTVS

Page 44: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• &H[C�#%I�BI��>/I7*B[-�!,WG�YX[mkrhnqj\�0E[`b!Z�TU<K

• +1e<K;��M3F9&H[?���M�=W PS��\I3:&HM2�VYNd]3:&He45Rc

• 3:&H\C�La28"DI3:&H[�'I(�IICU@�^V45

• ��[��_�'slpifqglonqjYX[.)Y&H?�e�=WRc��I

3�� �8WYTS��IENM�6Z$AVYJW OdS��t

• 28"��[ICU��E�6VENe�=WPUJc��Z\�Q&He�C

Page 45: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Methods outcome?Primary Outcome@WXSV��90 ��K$�$�

?Secondary Outcome@*�#9(90 NGJ8�)90 9K'�K$�(28 -�M:#9�K$�$�WXSV�Z28 -NGKICU-freeAOBLhospital-free#9WXSV�Z28 -NGK2�RUYT�6I#9�����.)>!��>�7K1�"+%Q�CFBO �

WXSV�Z28 -NGK5&�=;�(H/<0,�34��DPE �

Page 46: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• Primary Outcome(��(%*!�����(582')7&(1784.",#$* �

� (≧65� or <65�)

��(��!sepsis!������!��3/49���vs.���:)

Australian and Newzealand Risk of Death Score'+-�����620(5���(ANZICS CORE)

Body mass index(<18.5!18.5;24.9!25.0;29.9!≧30.0)

Page 47: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Methods Statistical analysis• 2:38%�9#0B3-ATARGETKWR8�&%�PSV7>@�"

• TARGET�" !(�5ANZICS CORE��� MWJQWH.?8NWJC<57,QWHSEV890����C20-30%5��⇒��80% 4,��7>@3.8-4.3%8*-/$);A5��1,GVPTGEIC3774�5�

•'�/ !6GVPTGEI9,OFUWDLP�+=�+%�7>@��2A5��1,4000�7��

Page 48: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

•�E?,U+�T1500�I90)!i]mp[djI7�KO*2Q(=⇒� O’Brien-Fleming0Z�4HP�U0.005?,fpcR��"Tkgcln_U358:SXYA

• LVPT?,Umodified intention-to-treat(ITT)Z���4Per-protocolHas-treated# ?,UprimaryosecondaryT�<Q(=/&�U>�NMH?,U�$KOfpcZWRS(=

B9�'U��R.1��WKJU�E�R���6�RKP@D

^e`lp�'UhpbnepaQ@D

• 2;ET�U��o�E(Hodges-Lehman%�C)o95qG�EQ@DB9�'S�KPUt-�WKJUWilcoxonTF��-�Z�4^e`lp�'S�KPU^\��-�Z�4

Page 49: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• 90�$�%<(��5�:95%�63=Log-binominal �� 9/2�/90+

��CAB?@!D

�)��1(��!)ü�7

üICU�4�<APACHE�SCOREüBMIü�(Austraria or New Zealand)ü��

üICU�4&'(�*8�#�.8,��.)

• 28�$�%84�$�%>�";�-

Page 50: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• Log-binomialSKV8��9=6� ?%��3�?-�>@WOHL�!.�>BDModified poisson����E�#

• TXJR7C90�A;?"��0@Log-rank��; /5Kaplan-Meier�);&:

•NGYM <95%�40@Cox �NGYMSKVE�#

• ICU5$25*�FQYLPUY�0@�0�<���'�E�#

•+�@SPSS(,IPL(Version22�1)<StataIPL(Verision15.1)E�#

Page 51: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Result

Page 52: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2
Page 53: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

1971�1986�

Page 54: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

�!57��!6���

����!84kg��IBW!64kg��BMI!29

ICU����!���7�

� �� �!7%

APACHE�score!��22

ICU����� ���!��14��

Page 55: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

�line�1.5kcal �����• EN1� #"%�(kcal/day)

• �1� #"%�

• IBW���� #"%�

• ������ #"%�

• ��

• �����

• �������

• �$!"$�

Page 56: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2
Page 57: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

����� ����65%���⇓

1.5kcal⇒103%�27%���� �1.0kcal⇒69%�18%���� �

��������������

Page 58: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Primary Outcome

�����

Secondary Outcome���

�����

Page 59: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

90����������28����� �����������������������Per-protocol������

Page 60: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

90��������

Page 61: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Sub group��

�����������������

Quintile for risk ofdeathBMI

����� 90 ��������

Page 62: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Discussion

Page 63: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• �!9I�A0%�IRCTUIA.���6Z+K47$H�V=�Z47$H�`)<

• +K47$HZ�-[I/'bgfi`&Y�@⇒(�,\I8�F�IE"CX[�GNWLRQ

• ?�Zopen-label RCT\meta13[A.�6Z$H��BXSKT:�NTK^MI��bgfi� Voutcome��ZD>[2PTKWKJ

⇒NLNIcadeah[*;BX�_PT25-30kcal/kg/dayZ��`��NTK^J

⇒��Z5#[cadeah` �O^�V[W]WLRQJ

Page 64: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

• Outcome>"�?& �+(<KMJQTN)�:CFD<387

1. �=0�.��4�2�$:CFD<3875;⇒�.��>*�>� <��?<27BBMI:��

�>2%>�$4BMI18.5��⇒5EA:>�.��>�!3D?-�6E927

2. �>1/34BMI30��>%��$:187⇒IGLOGS:?�HRPT(11-14kcal/kg/day)U/'��.4��⇒hypocaloricCeucaloricC'�,4#�6EE@"�?FD<387

Page 65: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

•�G(�8�=_OA9c$N �Jb��a\]DVi⇒��b25^e �Jb�S\[1.5kcal<^�S\[⇒�=0aLX]cO'E�f?C*�aeL�Yi�>�Qh

• �*�TRgZ50%/`in4Mb;@$N�j�.⇒!��b3�W_1.5kcal<^boverfeedingbmlkjFUi[dP1% B7c�)IghIBWj�.(IBW:29.1kcal/kg/day ABW:23.1kcal/kg/day)

⇒OverfeedingjFU[V_^&�,c�<^�c`S\[�H�+: P�����8-"KP�#0��,6�<^�c`X

Page 66: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

1. ��C &���'!"?D�.�(,C��D?5A3=<⇒JPSLU�(,B�.��,HG;F7@4� 3��

2. �.��,@��C-*DA3=<4/�.��CNIQTME%���@-�:F�$�40F

⇒%���,D+�C!"EKIORITC��,H)2>1F%�����H�#?9B8/JPSLU,C��H�6>!"

Limitation

Page 67: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

3. ENK�-FICU�9�24 7�I0� J��F6�AND⇒ENJ��QVUX�5J�!��K�=,"I�:BH>ED

4YUW4$�K1.5kcal-FOC>I�>ED⇒�UW1&�.IKQVUX�8?3GJPTSWR?<M?;��J)+FKsystematicHQVUX�8K2OH>ED

5Y��J)+J��?*(#'J�.F<M⇒�*#'LB@K���.FK%HM,"IHM�/�?<M

Page 68: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

Conclusion

�����!����"�����%

���&()'*�%�$����

�� !#��%�� ���

Page 69: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

•��'��#(1.5kcal/ml�(30kcal/kg/day)$1.0kcal/ml� (20kcal/kg/day)(���.+%�! �

⇒BMI���%�#(�1g/kg/day��'���������-"�-)�EN(+PN)&*, ���#�(�.+%�

��

Page 70: 120 - jseptic.com · Permissive Underfeeding[IIT EDEN SPN PermiT Design [Patient 2

•�ORCT�NBMI30��K�?"�3�M�?:4\1 �.E�9

⇒�>/Z[6;JPICU��O��23)�

⇒�8NSHIP�9-E$MU2�EAU]Refeeding%�-O[YX�.QBU2�^

⇒Refeeding%�-O[YX�.JP@�?�=W5HG�E3B2�

• OutcomeP��#J�- VTMB

⇒QOLRADL+PLCD_

]�?"�3�M�.P@*�'M�?&�J��#P VTMBE@ADL\,0<MLP��FU2�PAUD_^

(7

Clinical Nutrition xxx (2018) 1e32

Lancet Respir Med 2015;3:943-52→ 2016.02.23OJC�!


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