Kate Fetterplace1,2,3, Adam M Deane3,4, Audrey Tierney2,5, Lisa J Beach6, Laura D Knight6, Jeffrey Presneill3,4, Thomas Rechnitzer4, Adrienne Forsyth2, Benjamin M T Gill1,3, Marina Mourtzakis7, Christopher MacIsaac3,4. 1. Allied Health (Clinical Nutrition), Royal Melbourne Hospital, Melbourne, Australia. 2. Department of Rehabilitation, Nutrition and Sport, School of Allied Health, La Trobe University, Melbourne, Australia. 3. Department of Medicine, The University of Melbourne, Melbourne, Australia. 4. Department of Intensive Care Medicine, Royal Melbourne Hospital, Melbourne, Australia. 5. Department of Clinical Therapies, University of Limerick, Limerick, Ireland. 6. Allied Health (Physiotherapy), Royal Melbourne Hospital, Melbourne, Australia. 7. Department of Kinesiology, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada.
Abstract
BACKGROUND: International guidelines recommend greater protein delivery to critically ill patients than they currently receive. This pilot randomized clinical trial aimed to determine whether a volume-target enteral protocol with supplemental protein delivered greater amounts of protein and energy to critically ill patients compared with standard care. METHODS:Sixty participants received either theintervention (volume-based protocol, with protein supplementation) or standard nutrition care (hourly-rate-based protocol, without protein supplementation) in the intensive care unit (ICU). Coprimary outcomes were average daily protein and energy delivery. Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) and malnutrition (subjective global assessment) at ICU discharge. RESULTS:Mean (SD) protein and energy delivery per day from nutrition therapy for the intervention were 1.2 (0.30) g/kg and 21 (5.2) kcal/kg compared with 0.75 (0.11) g/kg and 18 (2.7) kcal/kg for standard care. The mean difference between groups in protein and energy delivery per day was 0.45 g/kg (95% CI, 0.33-0.56; P < .001) and 2.8 kcal/kg (95% CI, 0.67-4.9, P = .01). Muscle loss (QMLT) at discharge was attenuated by 0.22 cm (95% CI, 0.06-0.38, P = .01) in patients receiving the intervention compared with standard care. The number of malnourished patients was fewer in the intervention [2 (7%) vs 8 (28%); P = .04]. Mortality and duration of admission were similar between groups. CONCLUSIONS: A high-protein volume-based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge.
RCT Entities:
BACKGROUND: International guidelines recommend greater protein delivery to critically illpatients than they currently receive. This pilot randomized clinical trial aimed to determine whether a volume-target enteral protocol with supplemental protein delivered greater amounts of protein and energy to critically illpatients compared with standard care. METHODS: Sixty participants received either the intervention (volume-based protocol, with protein supplementation) or standard nutrition care (hourly-rate-based protocol, without protein supplementation) in the intensive care unit (ICU). Coprimary outcomes were average daily protein and energy delivery. Secondary outcomes included change in quadriceps muscle layer thickness (QMLT, ultrasound) and malnutrition (subjective global assessment) at ICU discharge. RESULTS: Mean (SD) protein and energy delivery per day from nutrition therapy for the intervention were 1.2 (0.30) g/kg and 21 (5.2) kcal/kg compared with 0.75 (0.11) g/kg and 18 (2.7) kcal/kg for standard care. The mean difference between groups in protein and energy delivery per day was 0.45 g/kg (95% CI, 0.33-0.56; P < .001) and 2.8 kcal/kg (95% CI, 0.67-4.9, P = .01). Muscle loss (QMLT) at discharge was attenuated by 0.22 cm (95% CI, 0.06-0.38, P = .01) in patients receiving the intervention compared with standard care. The number of malnourished patients was fewer in the intervention [2 (7%) vs 8 (28%); P = .04]. Mortality and duration of admission were similar between groups. CONCLUSIONS: A high-protein volume-based protocol with protein supplementation delivered greater amounts of protein and energy. This intervention was associated with attenuation of QMLT loss and reduced prevalence of malnutrition at ICU discharge.
Authors: Wolfgang H Hartl; Michael Hiesmayr; Martin Matejovic; Olivier Huet; Karolien Dams; Gunnar Elke; Clara Vaquerizo Alonso; Akos Csomos; Łukasz J Krzych; Romano Tetamo; Zudin Puthucheary; Olav Rooyackers; Inga Tjäder; Helmut Kuechenhoff Journal: Crit Care Date: 2022-05-18 Impact factor: 19.334
Authors: Daren K Heyland; Andrew Day; G John Clarke; Catherine Terri Hough; D Clark Files; Marina Mourtzakis; Nicolaas Deutz; Dale M Needham; Renee Stapleton Journal: BMJ Open Date: 2019-07-31 Impact factor: 2.692
Authors: Christian Stoppe; Sebastian Wendt; Nilesh M Mehta; Charlene Compher; Jean-Charles Preiser; Daren K Heyland; Arnold S Kristof Journal: Crit Care Date: 2020-08-12 Impact factor: 9.097
Authors: Kym Wittholz; Kate Fetterplace; Yasmine Ali Abdelhamid; Jeffrey J Presneill; Lisa Beach; Benjamin Thomson; David Read; René Koopman; Adam M Deane Journal: Pilot Feasibility Stud Date: 2022-01-31