TY - JOUR
T1 - Achieving protein targets without energy overfeeding in critically ill patients: A prospective feasibility study
AU - Looijaard, Willem
AU - Denneman, Nadine
AU - Broens, Bo
AU - Girbes, Armand
AU - Weijs, Peter J. M.
AU - Oudemans van Straaten, Heleen
N1 - With supplementary file: Appendix A, tables 1-3.
PY - 2019/12
Y1 - 2019/12
N2 - Background & aims: High protein delivery during early critical illness is associated with lower mortality, while energy overfeeding is associated with higher mortality. Protein-to-energy ratios of traditional enteral formulae are sometimes too low to reach protein targets without energy overfeeding. This prospective feasibility study aimed to evaluate the ability of a new enteral formula with a high protein-to-energy ratio to achieve the desired protein target while avoiding energy overfeeding. Methods: Mechanically ventilated non-septic patients received the high protein-to-energy ratio nutrition during the first 4 days of ICU stay (n = 20). Nutritional prescription was 90% of measured energy expenditure. Primary endpoint was the percentage of patients reaching a protein target of ≥1.2 g/kg ideal body weight on day 4. Other endpoints included a comparison of nutritional intake to matched historic controls and the response of plasma amino acid concentrations. Safety endpoints were gastro-intestinal tolerance and plasma urea concentrations. Results: Nineteen (95%) patients reached the protein intake target of ≥1.2 g/kg ideal body weight on day 4, compared to 65% in historic controls (p = 0.024). Mean plasma concentrations of all essential amino acids increased significantly from baseline to day 4. Predefined gastro-intestinal tolerance was good, but unexplained foul smelling diarrhoea occurred in two patients. In one patient plasma urea increased unrelated to acute kidney injury. Conclusions: In selected non-septic patients tolerating enteral nutrition, recommended protein targets can be achieved without energy overfeeding using a new high protein-to-energy ratio enteral nutrition. Keywords: Amino acids; Caloric overfeeding; Critical illness; Gastro-intestinal tolerance; High protein; Intensive care unit.
AB - Background & aims: High protein delivery during early critical illness is associated with lower mortality, while energy overfeeding is associated with higher mortality. Protein-to-energy ratios of traditional enteral formulae are sometimes too low to reach protein targets without energy overfeeding. This prospective feasibility study aimed to evaluate the ability of a new enteral formula with a high protein-to-energy ratio to achieve the desired protein target while avoiding energy overfeeding. Methods: Mechanically ventilated non-septic patients received the high protein-to-energy ratio nutrition during the first 4 days of ICU stay (n = 20). Nutritional prescription was 90% of measured energy expenditure. Primary endpoint was the percentage of patients reaching a protein target of ≥1.2 g/kg ideal body weight on day 4. Other endpoints included a comparison of nutritional intake to matched historic controls and the response of plasma amino acid concentrations. Safety endpoints were gastro-intestinal tolerance and plasma urea concentrations. Results: Nineteen (95%) patients reached the protein intake target of ≥1.2 g/kg ideal body weight on day 4, compared to 65% in historic controls (p = 0.024). Mean plasma concentrations of all essential amino acids increased significantly from baseline to day 4. Predefined gastro-intestinal tolerance was good, but unexplained foul smelling diarrhoea occurred in two patients. In one patient plasma urea increased unrelated to acute kidney injury. Conclusions: In selected non-septic patients tolerating enteral nutrition, recommended protein targets can be achieved without energy overfeeding using a new high protein-to-energy ratio enteral nutrition. Keywords: Amino acids; Caloric overfeeding; Critical illness; Gastro-intestinal tolerance; High protein; Intensive care unit.
KW - Amino acids
KW - Caloric overfeeding
KW - Critical illness
KW - Gastro-intestinal tolerance
KW - High protein
KW - Intensive care unit
UR - http://www.scopus.com/inward/record.url?scp=85059085985&partnerID=8YFLogxK
UR - https://pure.hva.nl/ws/files/6609382/1_s2.0_S0261561418325457_mmc1_1_.docx
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059085985&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30595377
U2 - https://doi.org/10.1016/j.clnu.2018.11.012
DO - https://doi.org/10.1016/j.clnu.2018.11.012
M3 - Article
C2 - 30595377
SN - 0261-5614
VL - 38
SP - 2623
EP - 2631
JO - Clinical nutrition (Edinburgh, Scotland)
JF - Clinical nutrition (Edinburgh, Scotland)
IS - 6
ER -