Hogeschool van Amsterdam

Urban Vitality

Achieving protein targets without energy overfeeding in critically ill patients: A prospective feasibility study

Article

<p><b>Background & aims: </b>High protein delivery during early critical illness is associated with lower mortality, while energy overfeeding is associated with higher mortality. Protein-to-energy ratios of traditional enteral formulae are sometimes too low to reach protein targets without energy overfeeding. This prospective feasibility study aimed to evaluate the ability of a new enteral formula with a high protein-to-energy ratio to achieve the desired protein target while avoiding energy overfeeding.</p><p><b>Methods:</b> Mechanically ventilated non-septic patients received the high protein-to-energy ratio nutrition during the first 4 days of ICU stay (n = 20). Nutritional prescription was 90% of measured energy expenditure. Primary endpoint was the percentage of patients reaching a protein target of ≥1.2 g/kg ideal body weight on day 4. Other endpoints included a comparison of nutritional intake to matched historic controls and the response of plasma amino acid concentrations. Safety endpoints were gastro-intestinal tolerance and plasma urea concentrations. </p><p><b>Results:</b> Nineteen (95%) patients reached the protein intake target of ≥1.2 g/kg ideal body weight on day 4, compared to 65% in historic controls (p = 0.024). Mean plasma concentrations of all essential amino acids increased significantly from baseline to day 4. Predefined gastro-intestinal tolerance was good, but unexplained foul smelling diarrhoea occurred in two patients. In one patient plasma urea increased unrelated to acute kidney injury. </p><p><b>Conclusions:</b> In selected non-septic patients tolerating enteral nutrition, recommended protein targets can be achieved without energy overfeeding using a new high protein-to-energy ratio enteral nutrition.</p>

Reference Looijaard, W. G. P. M., Denneman, N., Broens, B., Girbes, A. R. J., Weijs, P. J. M., & Oudemans-van Straaten, H. M. (2019). Achieving protein targets without energy overfeeding in critically ill patients: A prospective feasibility study. Clinical nutrition, 38(6), 2623-2631. https://doi.org/10.1016/j.clnu.2018.11.012
Published by  Urban Vitality 1 December 2019

Publication date

Dec 2019

Author(s)

W. G.P.M. Looijaard
N. Denneman
B. Broens
A.R.J. Girbes
H.M. Oudemans-van Straaten

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