BACKGROUND: Medical nutrition therapy may be associated with clinical outcomes in critically ill patients with prolonged intensive care unit (ICU) stay. We wanted to assess nutrition practices in European intensive care units (ICU) and their importance for clinical outcomes. METHODS: Prospective multinational cohort study in patients staying in ICU ≥ 5 days with outcome recorded until day 90. Macronutrient intake from enteral and parenteral nutrition and non-nutritional sources during the first 15 days after ICU admission was compared with targets recommended by ESPEN guidelines. We modeled associations between three categories of daily calorie and protein intake (low: < 10 kcal/kg, < 0.8 g/kg; moderate: 10-20 kcal/kg, 0.8-1.2 g/kg, high: > 20 kcal/kg; > 1.2 g/kg) and the time-varying hazard rates of 90-day mortality or successful weaning from invasive mechanical ventilation (IMV). RESULTS: A total of 1172 patients with median [Q1;Q3] APACHE II score of 18.5 [13.0;26.0] were included, and 24% died within 90 days. Median length of ICU stay was 10.0 [7.0;16.0] days, and 74% of patients could be weaned from invasive mechanical ventilation. Patients reached on average 83% [59;107] and 65% [41;91] of ESPEN calorie and protein recommended targets, respectively. Whereas specific reasons for ICU admission (especially respiratory diseases requiring IMV) were associated with higher intakes (estimate 2.43 [95% CI: 1.60;3.25] for calorie intake, 0.14 [0.09;0.20] for protein intake), a lack of nutrition on the preceding day was associated with lower calorie and protein intakes (- 2.74 [- 3.28; - 2.21] and - 0.12 [- 0.15; - 0.09], respectively). Compared to a lower intake, a daily moderate intake was associated with higher probability of successful weaning (for calories: maximum HR 4.59 [95% CI: 1.5;14.09] on day 12; for protein: maximum HR 2.60 [1.09;6.23] on day 12), and with a lower hazard of death (for calories only: minimum HR 0.15, [0.05;0.39] on day 19). There was no evidence that a high calorie or protein intake was associated with further outcome improvements. CONCLUSIONS: Calorie intake was mainly provided according to the targets recommended by the active ESPEN guideline, but protein intake was lower. In patients staying in ICU ≥ 5 days, early moderate daily calorie and protein intakes were associated with improved clinical outcomes. Trial registration NCT04143503 , registered on October 25, 2019.

1st Medical Department Faculty of Medicine in Pilsen Charles University and University Hospital in Pilsen Pilsen Czech Republic

Barts Health and Queen Mary University of London London England UK

CHRU La Cavale Blanche Brest France

Department of Anesthesiology and Intensive Care Medical University of Silesia Katowice Poland

Department of Anesthesiology and Intensive Care Medicine University Medical Center Schleswig Holstein Campus Kiel Kiel Germany

Department of Critical Care Medicine Antwerp University Hospital University of Antwerp Edegem Belgium

Department of Intensive Care Medicine Fuenlabrada University Hospital Madrid Spain

Division of Anesthesiology and Intensive Care Department of Clinical Science Intervention and Technology Karolinska Institutet Stockholm Sweden

Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care and Center for Medical Statistics Informatics and Intelligent Systems Medical University Vienna Spitalgasse 23 Vienna Austria

Karolinska University Hospital Perioperative Medicine and Intensive Care Huddinge Stockholm Sweden

Klinik für Allgemeine Viszeral und Transplantationschirurgie Klinikum der Universität Campus Grosshadern Ludwig Maximilians Universität München Marchioninistraße 15 81377 Munich Germany

MH EK Honvedkorhaz Budapest Hungary

Ospedale AUSL Reggio Emilia Reggio Emilia Italy

Statistisches Beratungslabor Institut für Statistik Ludwig Maximilians Universität München Munich Germany

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