Objective
To evaluate differences in outcomes for an optimized calorie and high protein
nutrition therapy versus standard nutrition care in critically ill adult
patients.
Methods
We randomized patients expected to stay in the intensive care unit for at
least 3 days. In the optimized calorie and high protein nutrition group,
caloric intake was determined by indirect calorimetry, and protein intake
was established at 2.0 to 2.2g/kg/day. The control group received
25kcal/kg/day of calories and 1.4 to 1.5g/kg/day protein. The primary
outcome was the physical component summary score obtained at 3 and 6 months.
Secondary outcomes included handgrip strength at intensive care unit
discharge, duration of mechanical ventilation and hospital mortality.
Results
In total, 120 patients were included in the analysis. There was no
significant difference between the two groups in calories received. However,
the amount of protein received by the optimized calorie and high protein
nutrition group was significantly higher compared with the control group.
The physical component summary score at 3 and 6 months did not differ
between the two groups nor did secondary outcomes. However, after adjusting
for covariates, a negative delta protein (protein received minus
predetermined protein requirement) was associated with a lower physical
component summary score at 3 and 6 months postrandomization.
Conclusion
In this study optimized calorie and high protein strategy did not appear to
improve physical quality of life compared with standard nutrition care.
However, after adjusting for covariates, a negative delta protein was
associated with a lower physical component summary score at 3 and 6 months
postrandomization. This association exists independently of the method of
calculation of protein target.
Background
We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients.
Methods
We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality).
Results
We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group (p < 0.0001). The PCS score was significantly higher in the HPE group at 3 months (p = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS.
Conclusion
This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients.
Trial registration
Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov (NCT03469882, March 19,2018).
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