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Wang Y, Ye Y, Xuan L, Xu L, Wang P, Ma J, Wang Y, Chen Y, Miao J, Wang W, Zhou L. Impact of early high protein intake in critically ill patients: a randomized controlled trial. Nutr Metab (Lond) 2024; 21:39. [PMID: 38943189 PMCID: PMC11212281 DOI: 10.1186/s12986-024-00818-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 06/24/2024] [Indexed: 07/01/2024] Open
Abstract
BACKGROUND Conflicting findings regarding the impact of High protein intake during the early phase in critically ill patients have been reported. Therefore, we aimed to assess the influence of higher early protein intake on the prognosis of critically ill patients. METHODS This randomized controlled trial involved 173 critically ill patients who stayed in the Intensive Care Unit/Emergency ICU (ICU/EICU) for at least 7 days. The Low group (n = 87) and High group (n = 86) received protein supplementation of 0.8 g/kg.d and 1.5 g/kg.d, respectively, within 1-3 days of enteral nutrition (EN) initiation, with both groups transitioning to 1.5 g/kg.d on the 4th day. The serum prealbumin (PA), blood urea nitrogen/creatinine, and rectus femoris muscle thickness and cross-sectional area of all patients was measured on the 1th, 3rd, 5th, 7th day, and the day of ICU/EICU discharge. RESULTS Patients in both Low and High groups showed no significant differences in age, APACHE II scores, or other demographic and baseline characteristics. There were also no significant differences in the primary outcome (28-day mortality rate) and secondary outcomes (incidence rate of refeeding syndrome and EN tolerance score) between the two groups. However, the Low group exhibited a significantly higher 28-day mortality rate (HR = 2.462, 95% CI: 1.021-5.936, P = 0.045) compared to High group, as determined by Cox proportional hazards models incorporating the time factor. The High group exhibited significantly shorter durations of mechanical ventilation and ICU stay compared to the Low group. Serum PA levels were higher, and rectus femoris muscle atrophy rates were lower in the High group. Furthermore, for septic patients, high protein intake significantly reduced the 28-day mortality rate despite a small sample size (n = 34). CONCLUSIONS Our study indicates that increasing early protein intake to 1.5 g/kg.d may be safe and help improve the nutritional status and prognosis of critically ill patients. TRIAL REGISTRATION This study was registered with the Chinese Clinical Trial Registry (ChiCTR2000039997, https://www.chictr.org.cn/ ).
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Affiliation(s)
- Yifei Wang
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Yanyang Ye
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Lusha Xuan
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Lijie Xu
- Department of science and education, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Pengpeng Wang
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Jun Ma
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Yuyan Wang
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Yanjun Chen
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China
| | - Jinli Miao
- The Yangtze River Delta Biological Medicine Research and Development Center of Zhejiang Province, Yangtze Delta Region Institution of Tsinghua University, Hangzhou, 314006, Zhejiang, China
| | - Wenmin Wang
- The Yangtze River Delta Biological Medicine Research and Development Center of Zhejiang Province, Yangtze Delta Region Institution of Tsinghua University, Hangzhou, 314006, Zhejiang, China
| | - Lingjie Zhou
- Intensive Care Unit, Zhuji Traditional Chinese Medical Hospital, Zhuji, 311800, Zhejiang, China.
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Hartwell JL, Evans DC, Martin MJ. Nutritional support for the trauma and emergency general surgery patient: What you need to know. J Trauma Acute Care Surg 2024; 96:855-864. [PMID: 38409684 DOI: 10.1097/ta.0000000000004283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
ABSTRACT Decades of research have provided insight into the benefits of nutritional optimization in the elective surgical patient. Patients who are nutritionally prepared for surgery enjoy reduced length of hospital and intensive care unit stays and suffer fewer complications. In the trauma and emergency general surgery patient populations, we are not afforded the preoperative period of optimization and patients often suffer longer lengths of hospital stay, discharge to nonhome destinations, and higher infectious and mortality rates. Nonetheless, ongoing research in this vulnerable and time critical diagnosis population has revealed significant outcomes benefits with the meticulous nutritional support of these patients. However, it is important to note that optimal nutritional support in this challenging patient population is not simply a matter of "feeding more and feeding earlier." In this review, we will address assessing nutritional needs, the provision of optimal nutrition, the timing and route of nutrition, and monitoring outcomes and discuss the management of nutrition in the complex trauma and emergency general surgery patient. LEVEL OF EVIDENCE Literature Synthesis and Expert Opinion; Level V.
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Affiliation(s)
- Jennifer L Hartwell
- From the Division of Acute Care Surgery, Department of Surgery (J.L.H.), University of Kansas Medical Center, Kansas Center, Kansas; Department of Surgery (D.C.E.), Ohio University, OhioHealth Grant Medical Center, Columbus, Ohio; and Division of Trauma and Surgical Critical Care (M.J.M.), Los Angeles County + USC Medical Center, Los Angeles, California
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