Summary Points and Consensus Recommendations From the International Protein Summit

Abstract

The International Protein Summit in 2016 brought experts in clinical nutrition and protein metabolism together from around the globe to determine the impact of high-dose protein administration on clinical outcomes and address barriers to its delivery in the critically ill patient. It has been suggested that high doses of protein in the range of 1.2-2.5 g/kg/d may be required in the setting of the intensive care unit (ICU) to optimize nutrition therapy and reduce mortality. While incapable of blunting the catabolic response, protein doses in this range may be needed to best stimulate new protein synthesis and preserve muscle mass. Quality of protein (determined by source, content and ratio of amino acids, and digestibility) affects nutrient sensing pathways such as the mammalian target of rapamycin. Achieving protein goals the first week following admission to the ICU should take precedence over meeting energy goals. High-protein hypocaloric (providing 80%-90% of caloric requirements) feeding may evolve as the best strategy during the initial phase of critical illness to avoid overfeeding, improve insulin sensitivity, and maintain body protein homeostasis, especially in the patient at high nutrition risk. This article provides a set of recommendations based on assessment of the current literature to guide healthcare professionals in clinical practice at this time, as well as a list of potential topics to guide investigators for purposes of research in the future.

Targeted Full Energy and Protein Delivery in Critically Ill Patients: A Pilot Randomized Controlled Trial (FEED Trial)

“…The current Society of Critical Care Medicine and American Society of Parenteral and Enteral Nutrition guidelines recommend that protein should be provided at a level of 1.2–2.0 g/kg/d, with possibly greater amounts for patients who are obese or present with multitrauma or burns, and other guidelines have similar recommendations (eg, European Society of Parenteral and Enteral Nutrition). However, there is a lack of high‐quality randomized controlled trials to support these protein recommendations …”

“…Observational data suggest that greater protein provision may be associated with improvements in survival, ventilator‐free days, and time to discharge alive from the intensive care unit (ICU) . Higher levels of protein provision may not only reduce mortality, but also stimulate the synthesis of new proteins and preserve muscle mass . Skeletal muscle preservation has been identified as an important surrogate outcome of ICU patients given the association between muscle loss and the development of ICU‐acquired weakness (ICUAW) .…”

“…The provision of nutrition via the enteral route is considered preferable; however, adequate delivery of protein and energy to critically ill patients via this route remains a challenge . Standard enteral feeding regimens are based on energy targets, and as a result protein delivery is more often restricted by the formula composition; this may result in protein prescriptions that are less than the current guidelines . Several methods to increase protein delivery via the enteral route have been proposed; these include the use of high‐protein formulas, volume‐based feeding protocols, and additional protein supplementation .…”

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

“…Critical illness can have a significant impact on protein needs . Providing adequate protein to critically ill patients may improve morbidity, mortality, and nitrogen accretion .…”

Parenteral and Enteral Nutrition—From Hospital to Home: Will It Be Covered?

“…They may need additional electrolytes, fluids, and macronutrients but not the full component to meet all of their daily caloric needs. In addition, 0.8–1.5 g/kg of protein is the recommended amount of protein to provide these patients, but certain patient populations may benefit from increased protein 66 …”