scholarly journals A new high protein-to-energy enteral formula with a whey protein hydrolysate to achieve protein targets in critically ill patients: a prospective observational tolerability study

2021 ◽  
Author(s):  
Franziska Tedeschi-Jockers ◽  
Simona Reinhold ◽  
Alexa Hollinger ◽  
Daniel Tuchscherer ◽  
Caroline Kiss ◽  
...  
Keyword(s):  
Whey Protein ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Protein Hydrolysate ◽  
Therapy Group ◽  
High Protein ◽  
Protein Targets ◽  
Gastrointestinal Side Effects ◽  
Whey Protein Hydrolysate

Abstract Objectives Current guidelines and expert recommendations stress the need to implement enteral feeds with a higher protein-to-energy ratio to meet protein requirements as recommended while avoiding gastrointestinal side effects and energy overfeeding in ICU patients. Materials and methods Prospective tolerability study in 18 critically ill patients with a high protein formula (high protein-to-energy (HP:E) formula = Fresubin® Intensive; HPG) compared to a contemporary matched conventional therapy group (CTG). The primary outcome was GI intolerance defined as ≥300 ml daily gastric residual volume (GRV), vomiting, or diarrhea on days 1 and 2. Secondary outcomes were the percentage of patients reaching their protein target on day 4 and overall protein intake. Results Groups were comparable regarding demographic characteristics, disease severity, organ failures, mechanical ventilation, and NUTRIC score at baseline. Eighteen patients completed the 4-day feeding period. The number of events of GRV of ≥300 ml/day was equal in both groups (33.3%). The incidence of diarrhea and vomiting was low in the HPG (two patients concerned). EN did not need to be discontinued due to intolerance in any group. Seventy-two percent of patients reached protein targets ≥1.3 g/kgBW/d within 4 days after initiation of enteral feeding, which was superior to the CTG (33%). Post-hoc testing showed group differences of protein intake between HPG and CTG were significant at t = 72 h and t = 96 h. Energy targets were met in both groups. Conclusion The HP:E formula containing 33% whey protein hydrolysate is well tolerated in this tolerability study. Due to the HP:E ratio protein targets can be reached faster. Larger randomized trials are needed to confirm preliminary results. Trial registration ClinicalTrials.gov Identifier: NCT02678325. Registered 2 May 2016.

scholarly journals Protein intake and outcome of critically ill patients: analysis of a large international database using piece-wise exponential additive mixed models

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Author(s):  
Wolfgang H. Hartl ◽  
Philipp Kopper ◽  
Andreas Bender ◽  
Fabian Scheipl ◽  
Andrew G. Day ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Critically Ill ◽  
Acute Phase ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
High Protein ◽  
Protein Diet ◽  
High Protein Intake ◽  
Low Protein ◽  
Standard Protein

Abstract Background Proteins are an essential part of medical nutrition therapy in critically ill patients. Guidelines almost universally recommend a high protein intake without robust evidence supporting its use. Methods Using a large international database, we modelled associations between the hazard rate of in-hospital death and live hospital discharge (competing risks) and three categories of protein intake (low: < 0.8 g/kg per day, standard: 0.8–1.2 g/kg per day, high: > 1.2 g/kg per day) during the first 11 days after ICU admission (acute phase). Time-varying cause-specific hazard ratios (HR) were calculated from piece-wise exponential additive mixed models. We used the estimated model to compare five different hypothetical protein diets (an exclusively low protein diet, a standard protein diet administered early (day 1 to 4) or late (day 5 to 11) after ICU admission, and an early or late high protein diet). Results Of 21,100 critically ill patients in the database, 16,489 fulfilled inclusion criteria for the analysis. By day 60, 11,360 (68.9%) patients had been discharged from hospital, 4,192 patients (25.4%) had died in hospital, and 937 patients (5.7%) were still hospitalized. Median daily low protein intake was 0.49 g/kg [IQR 0.27–0.66], standard intake 0.99 g/kg [IQR 0.89– 1.09], and high intake 1.41 g/kg [IQR 1.29–1.60]. In comparison with an exclusively low protein diet, a late standard protein diet was associated with a lower hazard of in-hospital death: minimum 0.75 (95% CI 0.64, 0.87), and a higher hazard of live hospital discharge: maximum HR 1.98 (95% CI 1.72, 2.28). Results on hospital discharge, however, were qualitatively changed by a sensitivity analysis. There was no evidence that an early standard or a high protein intake during the acute phase was associated with a further improvement of outcome. Conclusions Provision of a standard protein intake during the late acute phase may improve outcome compared to an exclusively low protein diet. In unselected critically ill patients, clinical outcome may not be improved by a high protein intake during the acute phase. Study registration ID number ISRCTN17829198

A Prospective Comparative Study of Moderate Versus High Protein Intake for Critically Ill Patients with Acute Renal Failure

Renal Failure ◽  
1997 ◽  
Vol 19 (1) ◽  
pp. 111-120 ◽  
Author(s):  
Rinaldo Bellomo ◽  
John Seacombe Bapplsci ◽  
Michael Daskalakis ◽  
Michael Farmer ◽  
Christopher Wright ◽  
...  
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Comparative Study ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
High Protein ◽  
High Protein Intake ◽  
Prospective Comparative Study

MON-P020: Early High Protein Intake without Energy Overfeeding in Critically Ill Patients

2017 ◽  
Vol 36 ◽  
pp. S186-S187
Author(s):  
W.G. Looijaard ◽  
N. Denneman ◽  
B. Broens ◽  
P.J. Weijs ◽  
H.M. Oudemans-van Straaten
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
High Protein ◽  
High Protein Intake

SUN-LB266: Feasibility of Early High Protein Intake by the Enteral Route in Critically Ill Patients

2016 ◽  
Vol 35 ◽  
pp. S143
Author(s):  
W.G. Looijaard ◽  
E.A. Worner ◽  
A.E. van derVeen ◽  
P.J. Weijs ◽  
H.M. Oudemans-van Straaten
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
High Protein ◽  
High Protein Intake

scholarly journals High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
José Raimundo Araujo de Azevedo ◽  
Hugo César Martins Lima ◽  
Pedro Henrique Dias Brasiliense Frota ◽  
Ivna Raquel Olimpio Moreira Nogueira ◽  
Suellen Christine de Souza ◽  
...  
Keyword(s):  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
High Protein ◽  
Control Group ◽  
High Protein Intake ◽  
Early Exercise ◽  
Icu Discharge ◽  
The Impact

Abstract Background We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients. Methods We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality). Results We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group (p < 0.0001). The PCS score was significantly higher in the HPE group at 3 months (p = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS. Conclusion This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients. Trial registration Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov (NCT03469882, March 19,2018).

scholarly journals Optimized calorie and high protein intake versus recommended caloric-protein intake in critically ill patients: a prospective, randomized, controlled phase II clinical trial

2019 ◽  
Vol 31 (2) ◽  
Author(s):  
José Raimundo Araújo de Azevedo ◽  
Hugo Cesar Martins Lima ◽  
Widlani Sousa Montenegro ◽  
Suellen Christine de Carvalho Souza ◽  
Ivna Raquel Olimpio Moreira Nogueira ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Critically Ill ◽  
Phase Ii ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
High Protein ◽  
Phase Ii Clinical Trial ◽  
High Protein Intake ◽  
Randomized Controlled

scholarly journals Feasibility of achieving different protein targets using a hypocaloric high-protein enteral formula in critically ill patients

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Pierre Singer ◽  
Itai Bendavid ◽  
Ilana BenArie ◽  
Liran Stadlander ◽  
Ilya Kagan
Keyword(s):  
Critically Ill ◽  
Nitrogen Balance ◽  
High Protein ◽  
Nitrogen Excretion ◽  
Protein Targets ◽  
Protein Target ◽  
Group A ◽  
Group B ◽  
Urinary Nitrogen Excretion ◽  
Urinary Nitrogen

Abstract Background and aims Combining 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. Methods Critically 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. Results Demographic 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. Conclusions Achieving 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.

scholarly journals Association of protein intake with the outcomes of critically ill patients: a post hoc analysis of the PermiT trial

2018 ◽  
Vol 108 (5) ◽  
pp. 988-996 ◽  
Author(s):  
Y M Arabi ◽  
H M Al-Dorzi ◽  
S Mehta ◽  
H M Tamim ◽  
S H Haddad ◽  
...  
Keyword(s):  
Propensity Score ◽  
Critically Ill ◽  
Nitrogen Balance ◽  
Critically Ill Patients ◽  
Protein Intake ◽  
Nitrogen Excretion ◽  
Post Hoc Analysis ◽  
Lower Protein ◽  
Protein Group ◽  
Post Hoc

ABSTRACT Background The optimal amount of protein intake in critically ill patients is uncertain. Objective In this post hoc analysis of the PermiT (Permissive Underfeeding vs. Target Enteral Feeding in Adult Critically Ill Patients) trial, we tested the hypothesis that higher total protein intake was associated with lower 90-d mortality and improved protein biomarkers in critically ill patients. Design In this post hoc analysis of the PermiT trial, we included patients who received enteral feeding for ≥3 consecutive days. Using the median protein intake of the cohort as a cutoff, patients were categorized into 2 groups: a higher-protein group (>0.80 g · kg–1 · d–1) and a lower-protein group (≤0.80 g · kg–1 · d–1). We developed a propensity score for receiving higher protein. Primary outcome was 90-d mortality. We also compared serial values of prealbumin, transferrin, 24-h urinary nitrogen, and 24-h nitrogen balance on days 1, 7, and 14. Results Among the 729 patients included in this analysis, the average protein intake was 0.8 ± 0.3 g · kg–1 · d–1 [1.0 ± 0.2 g · kg–1 · d–1 in the higher-protein group (n = 365) and 0.6 ± 0.2 g · kg–1 · d–1 in the lower-protein group (n = 364); P < 0.0001]. There was no difference in 90-d mortality between the 2 groups [88/364 (24.2%) compared with 94/363 (25.9%), propensity score–adjusted OR: 0.80; 95% CI: 0.56, 1.16; P = 0.24]. Higher protein intake was associated with an increase in 24-h urea nitrogen excretion compared with lower protein intake, but without a significant change in prealbumin, transferrin, or 24-h nitrogen balance. Conclusions In the PermiT trial, a moderate difference in protein intake was not associated with lower mortality. Higher protein intake was associated with increased nitrogen excretion in the urine without a corresponding change in prealbumin, transferrin, or nitrogen balance. Protein intake needs to be tested in adequately powered randomized controlled trials targeting larger differences in protein intake in high-risk populations.

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