Medical News Stories
Optimal Protein and Energy Nutrition Decreases Mortality in Mechanically Ventilated, Critically Ill Patients: A Prospective Observational Study
Weijs PJ, Stapel SN, de Groot SD, et al. JPEN J Parenter Enteral Nutr. 2012;36:60-8.
Study Question: Does optimizing the provision of energy and protein have a mortality benefit in mechanically-ventilated (MV), critically ill patients?
Study Description: Researchers conducted a prospective, observational study in a single, Dutch ICU wherein adult patients were included on ICU day 3-5 if their predicted requirement of “artificial nutrition” (via feeding tube or parenterally) was at least 5-7 additional days. Artificial nutrition was initiated within the first 24 hours and managed according to a specific, institution-developed nutrition policy. Patients were categorized into four groups depending on whether protein and/or energy targets were reached. The groups were classified based on targets reached: neither protein nor energy target (NT); both protein and energy (PET); only energy (ET); and only protein (PT). Calculated caloric goal was determined by the Harris-Benedict equation until indirect calorimetry was performed on day 3 to 5. Protein was provided to target 1.2-1.5 g/kg/day of preadmission body weight.
Results: Eight hundred eighty-six MV patients were included, with goal attainment as follows: 46.5% in NT; 27.7% in PET; 23.1% in ET; and 2.7% in PT. While the length of ICU and hospital stay, as well as the number of ventilator days, favored the NT group (p < 0.05), patients who reached both protein and energy targets were more likely to survive to hospital discharge (adjusted hazard ratio [HR] 0.70, 95% CI 0.53-0.94, p = 0.017) and 28 days (adjusted HR 0.51, 95% CI 0.33-0.78, p = 0.002).
Conclusion(s): In critically ill, MV patients, successfully reaching an energy target guided by indirect calorimetry and a protein target of 1.2-1.5 g/kg/day was associated with a nearly 50% decrease in 28-day mortality.
Perspective: This trial appears to address limitations of other studies where overfeeding critically ill patients with a low protein-to-energy ratio was of great concern, the limitations of its observational design notwithstanding.