Do We Have Clinical Equipoise (or Uncertainty) About How Much Protein to Provide to Critically Ill Patients?. (7th June 2019)

• Record Type: Journal Article
• Authors: Patel, Jayshil J.; Rice, Todd; Compher, Charlene; Heyland, Daren K.
• Is Part Of: Nutrition in clinical practice. Volume 35:Number 3(2020)
• Page Start: 499
• Page End: 505
• Publication Date: 2019-06-07
• Subjects: critical care -- critical illness -- equipoise -- nutrition support -- outcomes -- protein -- renal failure; Nutrition -- Periodicals; Diet therapy -- Periodicals; Artificial feeding -- Periodicals; 615.854
• DOI: 10.1002/ncp.10320
• Languages: English
• ISSNs: 0884-5336

Abstract

Abstract: The current recommendation for protein dose in critically ill patients is 1.2–2.0 g/kg/d. Despite this recommendation, there is significant variation in the amount of protein prescribed and delivered worldwide. We contend clinical equipoise, or a state of genuine uncertainty about 2 (dosing) strategies, exists because guideline‐based recommendations for protein dose in critically ill patients are rooted in a weak evidentiary base, leaving the clinician with no good basis for choosing a lower or higher protein dose. We outline evidence for and against high protein dose and introduce a pragmatic, registry‐based, multicenter, randomized controlled trial, known as EFFORT, which aims to resolve the high vs low protein dose controversy.