This multicenter study evaluated the effect of early nutritional support on clinical outcomes in ICU patients. The goal of the study was to determine whether introducing evidence-based feeding guidelines would both improve feeding in the ICU and decrease mortality rates.

Despite studies indicating that nutritional support within 24 hours of ICU admission may reduce the risk of death by 8% to 13%, the authors found that actual practice varies considerably, with as many as 40% of eligible patients receiving no nutrition even after 48 hours in the ICU. Eligible patients were those expected to have an ICU stay of longer than two days who were not scheduled to return to oral intake within 24 hours.

The authors developed an evidence-based algorithmic guideline to provide intervention patients with 80% of their nutritional needs within 72 hours of admission. The study enrolled 1,118 patients in 27 ICUs at 27 Australian and New Zealand hospitals between November 2003 and May 2004. The nutritional support guideline was followed in 561 patients in 14 ICUs; 557 patients in 13 ICUs served as the control group.

The results showed no significant difference in mortality rates, length of ICU stay, or length of hospital stay. However, the authors did find a clinically significant difference in the rates of renal dysfunction, with the guideline group faring better. They found no significant differences between the two groups in other organ function indicants, such as alveolar-arterial gradient, total bilirubin, platelets, systolic blood pressure, or multiple organ dysfunction. They did find, however, that significantly more intervention patients received nutritional support during their ICU stays, received it within 24 hours, and were fed on more days.

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