Abstract
Enteral nutrition (EN) is a ubiquitous intervention in ICU patients but there is uncertainty regarding the optimal dose, timing and importance for patient-centered outcomes during critical illness. Our research group has previously found an improved protein balance during normocaloric versus hypocaloric parenteral nutrition in neurosurgical ICU patients. We now wanted to investigate if this could be demonstrated in a general ICU population with established enteral feeding, including patients on renal replacement therapy. Patients with EN >80% of energy target as determined by indirect calorimetry were randomized to or 50% or 100% of current EN rate. After 24 hours, whole-body protein kinetics were determined by enteral and parenteral stable isotope tracer infusions. Treatment allocation was then switched, and tracer investigations repeated 24 hours later in a crossover design with patients serving as their own controls. Six patients completed the full protocol. During feeding with 100% EN all patients received >1.2 g/kg/day of protein. Mean whole-body protein balance increased from -6.07 to 2.93 µmol phenylalanine/kg/h during 100% EN as compared to 50% (p = 0.044). The oxidation rate of phenylalanine was unaltered (p = 0.78). It is possible to assess whole-body protein turnover using a stable isotope technique in critically ill patients during enteral feeding and renal replacement therapy. Our results also suggest a better whole-body protein balance during full dose as compared to half dose EN. As the sample size was smaller than anticipated, this finding should be confirmed in larger studies.
Highlights
The role of energy and protein delivery during critical illness remains unclear
Whole body protein kinetics in critically ill patients during 50 or 100% energy provision by enteral nutrition identification of research subjects
Our research group previously demonstrated that an increase in energy and protein delivery by total parenteral nutrition (TPN) from 50 to 100% of measured energy expenditure improves whole-body protein balance in neurosurgical Neurosurgical ICU (ICU) patients [12]
Summary
The role of energy and protein delivery during critical illness remains unclear. In recent years several large randomized controlled trials (RCTs) have failed to demonstrate a reduction in mortality from increased energy delivery during critical illness [1,2,3]. Results from several small RCTs have been conflicting [4,5,6,7,8] and currently there is insufficient data to conclude if energy and protein delivery within recommendations from clinical guidelines can ameliorate muscle loss in critically ill patients [9,10,11]. Our research group previously demonstrated that an increase in energy and protein delivery by total parenteral nutrition (TPN) from 50 to 100% of measured energy expenditure improves whole-body protein balance in neurosurgical ICU patients [12]. We wanted to investigate the effects of 50% versus 100% delivery of energy targets by EN on whole-body protein balance (primary outcome measure) and plasma amino acid profile (secondary outcome measure) in a general ICU population. We wanted to investigate if this could be demonstrated in a general ICU population with established enteral feeding, including patients on renal replacement therapy
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