Critical care (London, England)
August 28, 2026 · via Europe PMC
Indirect calorimetry-guided nutrition during weaning from prolonged mechanical ventilation: a double-blind randomized controlled trial.
Fradkin M, Elyashiv M, Brik M, +5 more, Dankner R.
AI summary — for doctors, generated from the abstract only
In a double-blind RCT of patients on prolonged mechanical ventilation, indirect calorimetry-guided feeding produced numerically better weaning and survival than predictive equations, but differences were not significant.
What was studied
A single-center double-blind RCT at an Israeli rehabilitation hospital (2019-2023) of 211 adults ventilated 21 days or more, randomized to indirect calorimetry-guided (n=111) or predictive equation-guided (n=100) energy targets.
Key findings
- Successful weaning 58% vs 50% (p=0.33).
- Median time to weaning 27 vs 31 days (p=0.58).
- 1-year mortality 48% vs 56% (difference -8%, 95% CI -21.2% to 5.5%).
- Post hoc: smaller energy gap associated with weaning success (HR 1.02 per 50 kcal/day reduction).
- IC-guided feeding reduced overfeeding.
Clinical relevance
This does not establish benefit of calorimetry-guided nutrition for weaning but supports further multicenter trials; it has limited direct ED relevance.
Who should care
Limitations
Single-center trial likely underpowered; key positive findings are post hoc.
Measuring energy needs to guide feeding during prolonged ventilation looked promising but wasn't proven.
This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.
Abstract
Purpose
To determine whether indirect calorimetry (IC)-guided nutritional prescriptions improve weaning success and time to liberation from prolonged mechanical ventilation (PMV) compared with predictive-equation-guided feeding.
Methods
In this double-blind randomized controlled trial conducted at Reuth Tel-Aviv Rehabilitation Hospital (Nov 2019-Apr 2023), with 1-year follow-up, adults ventilated ≥ 21 days were randomized to receive IC-guided energy targets or predictive-equation-guided feeding. Primary outcomes were successful weaning (≥ 7 consecutive days of spontaneous breathing) and time to successful weaning. Secondary outcomes included number of weaning cycles and 1-year mortality. Metabolic/nutritional safety parameters were recorded. Analyses followed the intention-to-treat principle, with additional per-protocol analyses. Time-to-event outcomes were evaluated using Kaplan-Meier estimates and Cox proportional hazards models.
Results
Among 211 randomized patients (111 IC; 100 control), successful weaning was achieved in 58% of the IC arm and 50% of the control arm (absolute difference 8%; p = 0.33). Median time to successful weaning was 27 vs. 31 days, respectively (p = 0.58). One-year mortality was 48% in the IC arm and 56% in the control arm (absolute difference of -8%, 95%CI: -21.2%, 5.5%; p = 0.29). In a post hoc analysis of the per-protocol cohort (n = 198), a smaller difference between measured energy expenditure and delivered energy intake (energy-gap) was independently associated with a higher likelihood of successful weaning (HR = 1.02 per 50-kcal/day reduction in the energy-gap; 95%CI: 1.00, 1.05; p = 0.02). IC-guided feeding resulted in closer alignment between measured energy expenditure and delivered energy intake and reduced the tendency toward overfeeding observed with predictive-equation-based prescriptions. Successful weaning was independently associated with lower one-year mortality (HR = 0.54; 95%CI: 0.36-0.82), adjusting for study arm.
Conclusion
The observed rates of successful weaning and one-year survival were numerically higher, and median time to liberation was shorter, with IC-guided nutrition than with predictive-equation-guided feeding, although between-group differences were not statistically significant. Closer alignment between measured energy expenditure and delivered energy intake was independently associated with successful weaning. These findings support further evaluation of energy delivery guided by measured energy expenditure in adequately powered multicenter trials.
Trial registration
ClinicalTrials.gov identifier NCT04825717. Registered March 15, 2021.
DOI
10.1186/s13054-026-06272-7
PMID
42791574
PMCID
PMC13613797
Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.
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