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Will We Ever Agree on Protein Requirements in the Intensive Care Unit?
L John Hoffer1, Roland N Dickerson2, Robert G Martindale3
11 Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Summary
Determining protein needs for critically ill patients is feasible using clinical trials. This approach incorporates physiological principles like nitrogen loss and muscle mass to guide protein requirements and optimize nutrition therapy.
Area of Science:
- Clinical Nutrition
- Critical Care Medicine
- Physiological Metabolism
Background:
- The normal adult protein requirement remains a subject of debate due to challenges in long-term studies with free-living individuals.
- Intensive care units offer a controlled environment suitable for clinical trials to determine protein needs in critically ill patients.
Purpose of the Study:
- To propose a framework for designing clinical trials to ascertain protein requirements in critically ill patients.
- To integrate fundamental physiological principles into the design of these trials.
Main Methods:
- Focus on three key physiological principles: measuring nitrogen loss, monitoring muscle mass, and accounting for energy balance.
- Designing hard clinical outcome trials comparing permissive underfeeding with hypocaloric nutrition supplemented with adequate protein.
Main Results:
- Nitrogen loss rate is a key indicator for increased minimum protein requirements.
- Muscle mass influences amino acid availability and identifies patients at risk of protein deficiency.
- Negative energy balance elevates protein requirements, necessitating specific trial designs for calorie-deprived patients.
Conclusions:
- Clinical outcome trials in intensive care units can effectively determine protein requirements for specific patient groups.
- Incorporating nitrogen balance, muscle mass monitoring, and energy status is crucial for accurate protein requirement assessment.
- Trials should compare current underfeeding practices with protein-enriched hypocaloric nutrition in critically ill patients.
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