High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Hoffer, L. John

doi:10.1002/ncp.10091

Cited by 14 publications

(34 citation statements)

References 118 publications

(350 reference statements)

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“…The concept of hypocaloric, high‐protein feeding as a nutrition strategy in the ICU has been garnering attention in recent years, in part owing to the work of Rugeles et al, who demonstrated that use of a 1.7 g/kg and 15 kcal/kg/d nutrition regime reduced severity of illness and hyperglycemia compared with a standard nutrition intervention with 25 kcal/kg/d and 20% protein calories . The European Society of Intensive Care Medicine's Early Enteral Nutrition Practice Guidelines recommend clinicians should not aim to cover full energy targets in early days of ICU admission and acknowledge hypocaloric feeding appears safe, whereas provision of excess energy may be harmful .…”

Section: Discussionmentioning

confidence: 99%

“…The average daily energy prescription was 1638.6 kcal ± 317.2 (990-2500) or 17.8 kcal/kg ± 5.4 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26). The average energy intake across all days (including calories from fatbased medication) was 1523.9 kcal/d ± 403.6 (693.0-2557.5) or 17.3 kcal/kg/d (±5.2, 8.7-27.8).…”

Section: Energymentioning

confidence: 99%

“…Despite the growing interest in protein delivery for acutely ill patients, little published evidence exists demonstrating that it is possible to meet prescribed protein targets enterally in this patient population. Clinicians may question if this lack of evidence is an indication that it is not feasible to deliver recommended protein doses using enteral nutrition therapy in the first week of critical illness . In 2016, a peptide‐based EN formula containing 37% calories from whey protein (92 g/L) and a lower NPC:N ratio of 43:1 became commercially available in Canada.…”

Section: Introductionmentioning

confidence: 99%

“…Commercially available enteral nutrition (EN) formulas with relatively low protein content have been implicated as contributing to inadequate protein intakes. 20,21 To meet the protein needs of tube fed patients, clinicians frequently use EN formulas that contain 18%-25% calories from protein and may add additional protein through use of supplemental enteral modular protein products or parenteral nutrition (PN). However, as Heyland et al observed from their INS data, despite the availability, modular proteins are used infrequently and contribute very little to most patients' overall protein intake.…”

Section: Introductionmentioning

confidence: 99%

“…Clinicians may question if this lack of evidence is an indication that it is not feasible to deliver recommended protein doses using enteral nutrition therapy in the first week of critical illness. 21 In 2016, a peptide-based EN formula containing 37% calories from whey protein (92 g/L) and a lower NPC:N ratio of 43:1 became commercially available in Canada. The purpose of this quality improvement (QI) study was 2-fold: (1) to improve protein provision in critically ill patients by demonstrating real-world experience that a specialized EN formula can deliver at least 80% of prescribed protein to ICU patients without overfeeding calories within the first 5 days of feeding; and (2) to describe formula tolerance and clinicians' indications for use.…”

Section: Introductionmentioning

confidence: 99%

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Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

et al. 2019

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Background To meet protein needs in critical illness (CI), guidelines suggest ≥1.2–2.5 g protein/kg/d; however, most intensive care unit (ICU) patients receive ≤0.7 g/kg/d. Higher protein enteral nutrition (EN) formulas may be part of the solution to provide prescribed protein. Our objective was to demonstrate that an EN formula with 37% protein can deliver ≥80% of prescribed protein, without overfeeding calories within the first 5 days of feeding and to describe ICU clinicians' experience. Methods This quality improvement (QI) project included patients requiring exclusive EN for up to 5 days from 6 Canadian ICUs. Rationale for choosing formula, patient's BMI (kg/m2), nutrition targets, daily protein and energy delivered, feeding interruptions, and general tolerance were recorded. Results Forty‐four of 49 patients received the formula ≥2 days. Average protein prescribed was 137.5 g/d (82.5–200) or 1.9 g/kg/d (1.5–2.5). Average protein delivered was 116.9 g/d (33.5–180) or 1.6 g/kg/d (0.4–2.4). Seventy‐five percent to 83% of patients received ≥80% prescribed protein on days 2–5. Average energy prescribed was 1638.6 kcal/d (990–2500) or 17.8 kcal/kg (11–26). Average energy delivered was 1523.9 kcal/d (693.0–2557.5) or 17.3 kcal/kg/d (1.35–64.7). The formula was well tolerated with no gastrointestinal symptoms reported in 38 (86%) patients. The most common reasons to prescribe the formula were obesity and use of fat‐based medications. Conclusions We demonstrated in a QI study that a high‐protein EN formula was tolerated in a small, heterogeneous group of ICU patients and effective in meeting protein targets without overfeeding.

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Section: Discussionmentioning

confidence: 99%

Section: Energymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

et al. 2019

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The association between enteral nutrition with survival of critical patients with COVID‐19

Gholamalizadeh,

Salimi,

Mobarakeh

et al. 2024

Immunity Inflam & Disease

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BackgroundCoronavirus disease 2019 (COVID‐19) results in several complications and mortality in intensive care unit (ICU) patients. Limited studies have investigated the effect of enteral nutrition (EN) on the survival of COVID‐19 patients in the ICU. The aim of this study was to investigate the association of EN with biochemical and pathological indices associated with mortality in ICU patients with COVID‐19.MethodsThis case–control study was conducted on 240 patients with COVID‐19 hospitalized in the ICU including 120 eventual nonsurvived as the cases and 120 survived patients as the controls. All of the patients received EN as a high protein high volume or standard formula. Data on general information, anthropometric measurements, and the results of lab tests were collected.ResultsThe recovered patients received significantly more high protein (60.8% vs. 39.6%, p = .004) and high volume (61.6% vs. 42.3%, p = .005) formula compared to the nonsurvived group. Mortality was inversely associated with high volume (odds ratio [OR]: 0.45 confidence interval [CI]95%, p = .008) and high protein (OR: 0.42 CI95%, p = .003) formula. The results remained significant after adjusting for age and sex. Further adjustment for underlying diseases, smoking, body mass index, and the acute physiology and chronic health evaluation II (APACHE II) score did not change the results.ConclusionThe findings of the study showed that there was a significant inverse association between mortality and high volume and high protein formula in patients with COVID‐19. Further investigation is warranted.

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Narrowing the Protein Deficit Gap in Critically Ill Patients Using a Very High‐Protein Enteral Formula

et al. 2020

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Background: Protein deficits have been associated with longer intensive care unit (ICU) stays and increased mortality. Current view suggests if protein goals are met, meeting full energy targets may be less important and prevent deleterious effects of overfeeding. We proposed a very-high protein (VHP) enteral nutrition (EN) formula could provide adequate protein, without overfeeding energy, in the first week of critical illness. Methods: This was a retrospective study of medical/surgical ICU patients receiving EN exclusively for ≥5 days during the first week of ICU admission. Twenty participants received standard EN; 20 participants received the VHP-EN formula (1 kcal/mL, 37% protein). Protein and energy prescribed/received, gastrointestinal tolerance, and feeding interruptions were examined. Results: Forty ICU patients [average Acute Physiology and Chronic Health Evaluation II score of 20.1] were included. Protein prescribed and received was significantly higher in the VHP group vs the standard EN group (135.5 g/d ± 22.9 vs 111.4 g/d ± 25; P = .003 and 112.2 g/d ± 27.8 vs 81.7 g/d ± 16.7, respectively; P = .002). Energy prescribed and received was similar between groups (1696 kcal/d ± 402 vs 1893 kcal/d ± 341, respectively; P = .101 and 1520 kcal/d ± 346 vs 1506 ± 380 kcal/d; P = .901). There were no differences in EN tolerance (P = .065) or feeding interruptions (P = .336). Conclusions: Use of a VHP formula in ICU patients resulted in higher protein intakes without overfeeding energy or use of modular protein in the first 5 days of exclusive EN.

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High‐Protein Hypocaloric Nutrition for Non‐Obese Critically Ill Patients

Cited by 14 publications

References 118 publications

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

Achieving Protein Targets in the ICU Using a Specialized High‐Protein Enteral Formula: A Quality Improvement Project

The association between enteral nutrition with survival of critical patients with COVID‐19

Narrowing the Protein Deficit Gap in Critically Ill Patients Using a Very High‐Protein Enteral Formula

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