Indirect Calorimetry Guided Energy Provision in Critically Ill Patients With Obesity

The DIRECT trial is a feasibility study testing whether using indirect calorimetry — a device that measures how many calories a critically ill patient actually burns — to guide nutrition delivery in ICU patients with obesity is practical and can be done consistently across multiple hospitals in Australia and New Zealand. Standard nutrition guidelines use mathematical formulas to estimate calorie needs, but these estimates may be inaccurate in patients with obesity, and personalized energy delivery may improve outcomes. Eligible participants are adult ICU patients aged 18 or older with a BMI of 30 or higher, who are between days 3–6 of their ICU stay, on a mechanical ventilator, and receiving enteral or parenteral (tube or IV) nutrition; those on ECMO or with burns covering more than 20% of the body are excluded. Participation involves being randomized to receive nutrition based on indirect calorimetry measurements or standard formula-based care, with clinical and nutritional outcomes tracked throughout the ICU stay. This summary was prepared using AI to help patients understand the study in plain language.