Early enteral nutrition in critically ill patients with a high-protein diet enriched with arginine, fiber, and antioxidants compared with a standard high-protein diet. The effect on nosocomial infections and outcome

Background: This study was designed to evaluate the effects of a high-prote in formula enriched with arginine, fiber, and antioxidants compared with a standard high-protein formula in early enteral nutrition in critically ill patients. Methods: For this study, 220 patients were enrolled in a prospect ive, multicenter, single-blind, randomized trial in 15 Spanish intensive ca re units (ICUs). The primary endpoints were the incidence density rates of nosocomial infections, ICU and hospital length of stay, ICU and in-hospital mortality, and mortality at 6-month follow-up. Results: The patients in th e control and study groups had similar baseline characteristics. The study group had a lower incidence of catheter-related sepsis (0.4 episodes/1000 I CU days) than the control group (5.5 episodes/1000 ICU days), with a relati ve risk (RR) of 0.07 (95% confidence interval [CI] 0.01 to 0.54, P < .001). There were no differences in the incidence of ventilator-associated pneumo nia, surgical infection, bacteremia, or urinary tract infections between th e 2 groups. ICU mortality (16% in the study group versus 21% in the control group; RR 1.5, Cl 95% 0.7 to 2.9) and in-hospital mortality (21% in the st udy group versus 30% in the control group; RR 1.6, CI 95% 0.9 to 3) were si milar without differences in survival at 6-month follow-up (75% in the stud y group versus 68% in the control group, p = .15). Patients in the study gr oup who were treated for 2 or more days showed a strong trend for better su rvival at 6-month follow-up (76% in the study group versus 67% in the contr ol group, p = .06). Medical patients treated with the study diet had better survival than medical patients in the control group (76% in the study grou p versus 59% in the control group, p < .05). Conclusions: Critically ill pa tients fed a high-protein diet enriched with arginine, fiber, and antioxida nts had a significantly lower catheter-related sepsis rate than patients fe d a standard high-protein diet. There were no differences in mortality or I CU and hospital length of stay. The subgroup of patients fed the study diet for >2 days showed a trend toward decreased mortality.