Use of a High‐Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel‐Group, Feasibility Trial

Chapple, Lee‐anne S.; Summers, Matthew J.; Bellomo, Rinaldo; Chapman, Marianne J.; Davies, Andrew R.; Ferrie, Suzie; Finnis, Mark; Hurford, Sally; Lange, Kylie; Little, Lorraine; O’Connor, Stephanie N.; Peake, Sandra; Ridley, Emma J.; Young, Paul; Williams, Patricia J.; Deane, Adam M

doi:10.1002/jpen.2059

Cited by 33 publications

(42 citation statements)

References 33 publications

(42 reference statements)

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“…Seven studies were conducted in Europe [ 15 , 25 , 27 , 30 , 33 , 35 , 37 ], four in Australia [ 24 , 26 , 32 , 39 ], four in Asia [ 14 , 19 , 28 , 36 ], two in North America [ 31 , 34 ], two in South America [ 29 , 38 ]. Nine studies included mixed medical and surgical population [ 14 , 24 – 27 , 29 , 30 , 32 , 39 ], four included patients with stroke or head injury [ 31 , 33 , 34 , 36 ], one included only medical [ 38 ], one included only surgical patients [ 15 ], and population studied (medical/surgical) was unclear in four studies [ 19 , 28 , 35 , 37 ]. One study included only overweight (BMI ≥ 25) [ 27 ], one included only obese (BMI ≥ 30) patients [ 35 ], and one included patients with non-oliguric acute renal failure requiring PN [ 37 ].…”

Section: Resultsmentioning

confidence: 99%

“…Nineteen RCTs totaling 1731 patients were included (sample size range: 14-474) [14,15,19,[24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39]. Study characteristics are summarized in Table 2.…”

Section: Studies and Patients Characteristicsmentioning

confidence: 99%

“…The duration of intervention ranged 3 to 28 days. Sixteen studies used an EN delivery strategy and 9 of them achieved higher protein by using an EN formula with higher protein content [19,25,27,30,[32][33][34][35][36]. Other patients' baseline and nutritional characteristics can be found in Additional file 2: Tables S4 and S5.…”

Section: Studies and Patients Characteristicsmentioning

confidence: 99%

“…Seven studies (n = 1027) reported ≥ 60-day mortality. Of these, 60-day [26,33], 3-month [34], 90-day [24,32,36] and 6-month [39] mortality were statistically aggregated. No difference was found in the overall (RR 0.99, 95% CI 0.78-1.24, p = 0.91; I 2 = 0%) or subgroup analyses (test for subgroup differences p = 0.65; I 2 = 0%) Additional file 3: Figure S5d.…”

Section: Mortalitymentioning

confidence: 99%

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The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

et al. 2021

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Background The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients. Methods We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes). Results Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75–1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD −3.44% per week, 95% CI −4.99 to −1.90; p < 0.0001). Conclusion In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery. PROSPERO registration number: CRD42021237530

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Section: Resultsmentioning

confidence: 99%

Section: Studies and Patients Characteristicsmentioning

confidence: 99%

Section: Studies and Patients Characteristicsmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

See 2 more Smart Citations

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

et al. 2021

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“…Protein delivery in the intervention group was higher (1.52 vs. 0.99 g/kg ideal body weight per day). No differences in the clinical outcomes including 90-day mortality were observed [ 52 ].…”

Section: “How Much?”—energy and Protein Requirementsmentioning

confidence: 99%

Nutrition in the Intensive Care Unit—A Narrative Review

Hill

Elke²,

Weimann

2021

Nutrients

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Background: While consent exists, that nutritional status has prognostic impact in the critically ill, the optimal feeding strategy has been a matter of debate. Methods: Narrative review of the recent evidence and international guideline recommendations focusing on basic principles of nutrition in the ICU and the treatment of specific patient groups. Covered topics are: the importance and diagnosis of malnutrition in the ICU, the optimal timing and route of nutrition, energy and protein requirements, the supplementation of specific nutrients, as well as monitoring and complications of a Medical Nutrition Therapy (MNT). Furthermore, this review summarizes the available evidence to optimize the MNT of patients grouped by primarily affected organ system. Results: Due to the considerable heterogeneity of the critically ill, MNT should be carefully adapted to the individual patient with special focus on phase of critical illness, metabolic tolerance, leading symptoms, and comorbidities. Conclusion: MNT in the ICU is complex and requiring an interdisciplinary approach and frequent reevaluation. The impact of personalized and disease-specific MNT on patient-centered clinical outcomes remains to be elucidated.

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Beta‐hydroxy‐beta‐methylbutyrate supplementation and functional outcomes in multitrauma patients: A pilot randomized controlled trial

Wittholz

Fetterplace

Karahalios

et al. 2023

J Parenter Enteral Nutr

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BackgroundBeta‐hydroxy‐beta‐methylbutyrate (HMB) is a nutrition supplement that may attenuate muscle wasting from critical illness. This trial aimed to determine feasibility of administering a blinded nutrition supplement in the intensive care unit (ICU) and continuing it after ICU discharge.MethodsSingle‐center, parallel‐group, blinded, placebo‐controlled, randomized feasibility trial. After traumatic injury necessitating admission to ICU, participants were randomized to receive an enteral study supplement of 3 g of HMB (intervention) or placebo daily for 28 days or until hospital discharge. Primary outcome was feasibility of administering the study supplement, quantified as protocol adherence. Secondary outcomes included change in quadriceps muscle thickness, measured weekly until day 28 or hospital discharge by using ultrasound and analyzed by using a linear mixed model.ResultsFifty randomized participants (intervention, n = 26; placebo, n = 24) showed comparable baseline characteristics. Participants received 862 (84.3%) of the 1022 prescribed supplements during hospitalization with 543 (62.8%) delivered via an enteral feeding tube. The median (IQR) number of study supplements successfully administered per participant was 19.5 (13.0–24.0) in the intervention group and 16.5 (8.5–23.5) in the placebo group. Marked loss of quadriceps muscle thickness occurred in both groups, with the point estimate favoring attenuated muscle loss with the intervention, albeit with wide CIs (mean intervention difference after 28 days, 0.26 cm [95% CI, −0.13 to 0.64]).ConclusionA blinded, placebo‐controlled, randomized clinical trial of daily enteral HMB supplementation for up to 28 days in hospital is feasible. Any effect of HMB supplementation to attenuate muscle wasting after traumatic injury remains uncertain.

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Use of a High‐Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel‐Group, Feasibility Trial

Cited by 33 publications

References 33 publications

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

Nutrition in the Intensive Care Unit—A Narrative Review

Beta‐hydroxy‐beta‐methylbutyrate supplementation and functional outcomes in multitrauma patients: A pilot randomized controlled trial

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