%0 Journal Article
%T A Randomized Noninferiority Trial to Compare Enteral to Parenteral Phosphate Replacement on Biochemistry, Waste, and Environmental Impact and Healthcare Cost in Critically Ill Patients With Mild to Moderate Hypophosphatemia.
%A Nguyen CD
%A Panganiban HP
%A Fazio T
%A Karahalios A
%A Ankravs MJ
%A MacIsaac CM
%A Rechnitzer T
%A Arno L
%A Tran-Duy A
%A McAlister S
%A Ali Abdelhamid Y
%A Deane AM
%J Crit Care Med
%V 52
%N 7
%D 2024 Jul 1
%M 38996440
%F 9.296
%R 10.1097/CCM.0000000000006255
%X <B>OBJECTIVE: </B>Hypophosphatemia occurs frequently. Enteral, rather than IV, phosphate replacement may reduce fluid replacement, cost, and waste.<BR><B>METHODS: </B>Prospective, randomized, parallel group, noninferiority clinical trial.<BR><B>METHODS: </B>Single center, 42-bed state trauma, medical and surgical ICUs, from April 20, 2022, to July 1, 2022.<BR><B>METHODS: </B>Patients with serum phosphate concentration between 0.3 and 0.75 mmol/L.<BR><B>METHODS: </B>We randomized patients to either enteral or IV phosphate replacement using electronic medical record-embedded program.<BR><B>RESULTS: </B>Our primary outcome was serum phosphate at 24 hours with a noninferiority margin of 0.2 mmol/L. Secondary outcomes included cost savings and environmental waste reduction and additional IV fluid administered. The modified intention-to-treat cohort comprised 131 patients. Baseline phosphate concentrations were similar between the two groups. At 24 hours, mean ( sd ) serum phosphate concentration were enteral 0.89 mmol/L (0.24 mmol/L) and IV 0.82 mmol/L (0.28 mmol/L). This difference was noninferior at the margin of 0.2 mmol/L (difference, 0.07 mmol/L; 95% CI, -0.02 to 0.17 mmol/L). When assigned IV replacement, patients received 408 mL (372 mL) of solvent IV fluid. Compared with IV replacement, the mean cost per patient was ten-fold less with enteral replacement ($3.7 [$4.0] vs. IV: $37.7 [$31.4]; difference = $34.0 [95% CI, $26.3-$41.7]) and weight of waste was less (7.7 g [8.3 g] vs. 217 g [169 g]; difference = 209 g [95% CI, 168-250 g]). C O2 emissions were 60-fold less for comparable phosphate replacement (enteral: 2 g producing 14.2 g and 20 mmol of potassium dihydrogen phosphate producing 843 g of C O2 equivalents).<BR><B>CONCLUSIONS: </B>Enteral phosphate replacement in ICU is noninferior to IV replacement at a margin of 0.2 mmol/L but leads to a substantial reduction in cost and waste.