High protein versus medium protein delivery under equal total energy delivery in critical care: A randomized controlled trial. Issue 3 (March 2021)

• Record Type: Journal Article
• Authors: Nakamura, Kensuke; Nakano, Hidehiko; Naraba, Hiromu; Mochizuki, Masaki; Takahashi, Yuji; Sonoo, Tomohiro; Hashimoto, Hideki; Morimura, Naoto
• Is Part Of: Clinical nutrition. Volume 40:Issue 3(2021)
• Page Start: 796
• Page End: 803
• Publication Date: 2021-03
• Subjects: Critical care -- Electrical muscle stimulation -- Immunosuppression and catabolism syndrome -- Nutrition -- Persistent inflammation, PICS -- Protein; ICU intensive care unit -- EMS electrical muscle stimulation -- PIICS persistent inflammation, immunosuppression and catabolism syndrome -- EN enteral nutrition -- PN parenteral nutrition -- CT computed tomography -- APACHE acute physiology and chronic health evaluation -- SOFA sequential organ failure assessment -- ADL activity of daily living -- QOL quality of life -- PICS post intensive care syndrome -- RCT randomized control trial -- GRV gastric residual volume -- SD standard deviation -- FSS-ICU functional status score for the ICU -- EQ-5D EuroQol 5 Dimension; Critically ill -- Nutrition -- Periodicals; Diet therapy -- Periodicals; Parenteral feeding -- Periodicals; Enteral feeding -- Periodicals; Enteral Nutrition -- Periodicals; Parenteral Nutrition -- Periodicals; Metabolism -- Periodicals; Diétothérapie -- Périodiques; Alimentation parentérale -- Périodiques; Alimentation entérale -- Périodiques; Nutrition -- Périodiques; Diet therapy; Enteral feeding; Nutrition; Parenteral feeding; Electronic journals; Periodicals; Electronic journals; 615.854
• DOI: 10.1016/j.clnu.2020.07.036
• Languages: English
• ISSNs: 0261-5614

Abstract

Summary: Background: Appropriate protein delivery amounts during the acute phase of critical care are unknown. Along with nutrition, early mobilization and the combination are important. We conducted a randomized controlled trial during critical care to assess high-protein and medium-protein delivery under equal total energy delivery with and without active early rehabilitation. Methods: ICU patients of August 2018–September 2019 were allocated to a high-protein group (target energy 20 kcal/kg/day, protein 1.8 g/kg/day) or a medium-protein group (target energy 20 kcal/kg/day, protein 0.9 g/kg/day) with the same nutrition protocol by day 10. By dividing the study period, standard rehabilitation was administered during the initial period. Rehabilitation with belt-type electrical muscle stimulation was given from day 2 in the latter as a historical comparison. Femoral muscle volume was evaluated on day 1 and day 10 using computed tomography. Results: This study analyzed 117 eligible patients with similar characteristics assigned to a high-protein or medium-protein group. Total energy delivery was around 20 kcal/kg/day in both groups, but protein delivery was 1.5 g/kg/day and 0.8 g/kg/day. As a primary outcome, femoral muscle volume loss was 12.9 ± 8.5% in the high-protein group and 16.9 ± 7.0% in the medium-protein group, with significant difference ( p = 0.0059). Persistent inflammation, immunosuppression, and catabolism syndrome were significantly less frequent in the high-protein group. Muscle volume loss was significantly less in the high-protein group only during the electrical muscle stimulation period. Conclusions: For critical care, high protein delivery provided better muscle volume maintenance, but only with active early rehabilitation. Registration: University Hospital Medical Information Network, UMIN000033783 Registered on 16 Aug 2018. https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000038538 .