Protein Provision in Critically Ill Adults Requiring Enteral Nutrition: Are Guidelines Being Met?

Abstract

Background In a previous audit, 81% of enteral protein prescriptions failed to meet protein guidelines. To address this, a very high‐protein enteral formula and protein supplements were introduced, and protein prescriptions were adjusted to account for nonnutrition energy sources displacing enteral formula. This follow‐up audit compared protein provision in critically ill adults requiring exclusive enteral nutrition (EN), first, with local and international guidelines, and second, after changes to practice, with the previous audit in the same intensive care unit (ICU). Methods Data were collected from 106 adults consecutively admitted to the ICU of a U.K. tertiary hospital and requiring exclusive EN ≥3 days. Protein targets based on local guidelines (1.25, 1.5, or 2.0 g/kg/d), nutrition prescription, and delivery were recorded for 24 hours between days 1–3, 5–7, 8–10, and 18–20 post‐ICU admission. Results The proportion of day 1–3 protein prescriptions meeting protein targets increased from 19% in 2015 to 69% in 2017 (P < .0005, φ = 0.50). The median percentage of protein target delivered was lower than prescribed (79% vs 103%; (P < .0005; r = 0.53) and EN delivery only met the target of 22% of patients. The proportion of protein prescriptions meeting protein targets was similar for days 1–3 (69%), 5–7 (71%), and 8–10 (68%), but increased slightly by days 18–20 (74%). The proportion of patients for which EN delivery met protein targets increased with the number of days post‐ICU admission (22%, 26%, 37%, and 53% for days 1–3, 5–7, 8–10, and 18–20, respectively). Conclusion The proportion of protein prescriptions meeting guideline targets was higher after changes to practice.

Protein requirements and provision in hospitalised COVID-19 ward and ICU patients: Agreement between calculations based on body weight and height, and measured bioimpedance lean body mass

“…However, proteins were generally underdelivered by either target. Our findings align with findings from other studies proving that adequate protein provision is difficult to achieve in the ICU population, including COVID-19 patients [8,20,21]. When comparing the percentage of target delivered as calculated by the other methods to Target BIA , all methods except Target Gallagher for males differed significantly.…”

A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice

“…Current data consistently demonstrate that ICU patients receive low amounts of protein (average of 0.6 g/ kg/day for the first two weeks) [24,[60][61][62][63][64][65][66][67]. Higher protein provision is associated with reduced mortality in adults in observational trials [61,[68][69][70][71][72][73][74], biochemical outcome parameters and morphometric outcomes in skeletal muscle [75][76][77][78][79], improved quality of life at 3-month post-ICU [69] or handgrip strength at hospital day 7 and muscle mass [73].…”

Effect of Whey Proteins on Malnutrition and Extubating Time of Critically Ill COVID-19 Patients

“…According to a standardized nutritional protocol for COVID-19 patients, each patient received EN applying the following nutritional scheme [17,18] EN was also administered to the patients during prone positioning, maintaining at least 10% of bed anti-Trendelenburg tilt, and to the patients treated with NIV and in the conditions of controlled hypoxemia and permissive hypercapnia. EN was started at 20 mL/h infusion rate and increased by 10 to 20 mL/h every 24 h, based on the gastric tolerability.…”

“…The needs of trace elements and vitamins supplementation were evaluated in previously malnourished patients, or in case of partial EN with or without complementary parenteral nutrition (administered 250 mL of 5% glucose solution in 5 to 6 h during the night-time, once a day, for three days as a loading dose, and then twice a week in the maintenance dose, respectively) [17,18].…”