Abstract
Background and aimsCombining energy and protein targets during the acute phase of critical illness is challenging. Energy should be provided progressively to reach targets while avoiding overfeeding and ensuring sufficient protein provision. This prospective observational study evaluated the feasibility of achieving protein targets guided by 24-h urinary nitrogen excretion while avoiding overfeeding when administering a high protein-to-energy ratio enteral nutrition (EN) formula.MethodsCritically ill adult mechanically ventilated patients with an APACHE II score > 15, SOFA > 4 and without gastrointestinal dysfunction received EN with hypocaloric content for 7 days. Protein need was determined by 24-h urinary nitrogen excretion, up to 1.2 g/kg (Group A, N = 10) or up to 1.5 g/kg (Group B, N = 22). Variables assessed included nitrogen intake, excretion, balance; resting energy expenditure (REE); phase angle (PhA); gastrointestinal tolerance of EN.ResultsDemographic characteristics of groups were similar. Protein target was achieved using urinary nitrogen excretion measurements. Nitrogen balance worsened in Group A but improved in Group B. Daily protein and calorie intake and balance were significantly increased in Group B compared to Group A. REE was correlated to PhA measurements. Gastric tolerance of EN was good.ConclusionsAchieving the protein target using urinary nitrogen loss up to 1.5 g/kg/day was feasible in this hypercatabolic population. Reaching a higher protein and calorie target did not induce higher nitrogen excretion and was associated with improved nitrogen balance and a better energy intake without overfeeding. PhA appears to be related to REE and may reflect metabolism level, suggestive of a new phenotype for nutritional status.Trial registration 0795-18-RMC.
Highlights
Nutritional therapeutic goals for critically ill patients should be aimed at minimizing the potential for malnutrition while avoiding overfeeding [1]
Thirty-two patients were included in the study: 10 in group of patients (Group A) and 22 in Group B
Nitrogen intake in Group A increased from 7.9 ± 2.6 g/d on day 1 to 11.6 ± 3.7 g/d on day 7
Summary
Nutritional therapeutic goals for critically ill patients should be aimed at minimizing the potential for malnutrition while avoiding overfeeding [1]. Because sufficient exogenous protein provision can mitigate skeletal muscle atrophy and improve some clinical outcomes [3, 4], professional guidelines endorse higher than normal daily protein intakes of between 1.2 and 2 g/kg/d [1, 5] in critical illness. These guidelines are, for the most part, based on observational studies due to a lack of evidence from randomized controlled trials. Energy should be provided progressively to reach targets while avoiding overfeeding and ensuring sufficient protein provision. This prospective observational study evaluated the feasibility of achieving protein targets guided by 24-h urinary nitrogen excretion while avoiding overfeeding when administering a high protein-to-energy ratio enteral nutrition (EN) formula
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