PermiT (post-hoc analysis, low-risk)
Trial question
What is the role of permissive underfeeding with full protein intake among ICU patients with low nutritional risk?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
29.0% female
71.0% male
N = 516
516 patients (152 female, 364 male).
Inclusion criteria: adult patients in the ICU with low nutritional risk receiving enteral feeding.
Key exclusion criteria: terminal illness; DNR order in the first 48 hours; enteral feeding cannot be started within 48 hours of admission; TPN or oral feeding; brain death within 48 hours of admission.
Interventions
N=259 permissive underfeeding (a goal of 40-60% caloric requirement with 1.2-1.5 g/kg/day protein intake).
N=257 standard feeding (a goal of 70-100% caloric requirement with 1.2-1.5 g/kg/day protein intake).
Primary outcome
Death at 90 days
18%
17.5%
18.0 %
13.5 %
9.0 %
4.5 %
0.0 %
Permissive
underfeeding
Standard
feeding
No significant
difference ↔
No significant difference in death at 90 days (18% vs. 17.5%; OR 1.01, 95% CI 0.64 to 1.61).
Secondary outcomes
No significant difference in length of ICU stay (13 days vs. 13 days; AD -0.04 days, 95% CI -1.9 to 1.8).
No significant difference in ventilation duration (9 days vs. 9 days; AD -2.6 days, 95% CI -5.9 to 0.7).
No significant difference in hospital death (15.8% vs. 16.8%; OR 0.9, 95% CI 0.56 to 1.45).
Safety outcomes
No significant differences in hypoglycemia, hypokalemia, hypomagnesemia, hypophosphatemia, infections, feeding intolerance, and diarrhea.
Conclusion
In adult patients in the ICU with low nutritional risk receiving enteral feeding, permissive underfeeding was not superior to standard feeding with respect to death at 90 days.
Reference
Yaseen M Arabi, Abdulaziz S Aldawood, Hasan M Al-Dorzi et al. Permissive Underfeeding or Standard Enteral Feeding in High- and Low-Nutritional-Risk Critically Ill Adults. Post Hoc Analysis of the PermiT Trial. Am J Respir Crit Care Med. 2017 Mar 1;195(5):652-662.
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