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Adequate enteral protein intake is inversely associated with 60-d mortality in critically ill children: a
Nilesh M Mehta1, Lori J Bechard2, David Zurakowski3
1Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, and Center for Nutrition, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; and nilesh.mehta@childrens.harvard.edu.
Insights
Adequate protein intake in mechanically ventilated children significantly lowers mortality risk. Delivering over 60% of prescribed protein in pediatric intensive care units (PICUs) improves survival outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Nutritional Science
- Clinical Research
Background:
- The role of protein intake in pediatric critical illness outcomes remains poorly understood.
- Optimizing nutrition is crucial for critically ill children.
Purpose of the Study:
- To investigate the association between protein intake and 60-day mortality in mechanically ventilated children.
- To identify factors influencing protein delivery adequacy.
Main Methods:
- Prospective, multicenter cohort study across 59 pediatric intensive care units (PICUs) in 15 countries.
- Enrolled 1245 mechanically ventilated children (1 month to 18 years) for at least 48 hours.
- Assessed daily and cumulative protein intake adequacy relative to prescribed goals during the first 10 days in the PICU.
Main Results:
- Protein intake adequacy was significantly associated with 60-day mortality (P < 0.001).
- Intake ≥60% of the prescribed goal showed a 0.14 odds ratio for mortality compared to <20% intake.
- Factors like early initiation, postpyloric route, and dedicated dietitians improved protein delivery.
Conclusions:
- Achieving >60% of prescribed protein intake is linked to reduced mortality in mechanically ventilated children.
- Optimizing protein prescription and bedside practices may enhance delivery and improve outcomes.
- Registered trial NCT02354521.
Background:
The impact of protein intake on outcomes in pediatric critical illness is unclear.
Objective:
We examined the association between protein intake and 60-d mortality in mechanically ventilated children.
Design:
In a prospective, multicenter, cohort study that included 59 pediatric intensive care units (PICUs) from 15 countries, we enrolled consecutive children (age: 1 mo to 18 y) who were mechanically ventilated for ≥48 h. We recorded the daily and cumulative mean adequacies of energy and protein delivery as a percentage of the prescribed daily goal during the PICU stay ≤10 d. We examined the association of the adequacy of protein delivery with 60-d mortality and determined variables that predicted protein intake adequacy.
Results:
We enrolled 1245 subjects (44% female) with a median age of 1.7 y (IQR: 0.4, 7.0 y). A total of 985 subjects received enteral nutrition, 354 (36%) of whom received enteral nutrition via the postpyloric route. Mean ± SD prescribed energy and protein goals were 69 ± 28 kcal/kg per day and 1.9 ± 0.7 g/kg per day, respectively. The mean delivery of enteral energy and protein was 36 ± 35% and 37 ± 38%, respectively, of the prescribed goal. The adequacy of enteral protein intake was significantly associated with 60-d mortality (P < 0.001) after adjustment for disease severity, site, PICU days, and energy intake. In relation to mean enteral protein intake <20%, intake ≥60% of the prescribed goal was associated with an OR of 0.14 (95% CI: 0.04, 0.52; P = 0.003) for 60-d mortality. Early initiation, postpyloric route, shorter interruptions, larger PICU size, and a dedicated dietitian in the PICU were associated with higher enteral protein delivery.
Conclusions:
Delivery of >60% of the prescribed protein intake is associated with lower odds of mortality in mechanically ventilated children. Optimal prescription and modifiable practices at the bedside might enhance enteral protein delivery in the PICU with a potential for improved outcomes. This trial was registered at clinicaltrials.gov as NCT02354521.
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