In mechanically ventilated patients at nutritional risk, high protein did not reduce time to discharge alive

Area of Science:

• Critical care medicine
• Clinical nutrition
• Intensive care unit (ICU) management

Background:

• Critically ill patients often have high nutritional requirements.
• Optimal protein dosing in these patients remains controversial.
• Previous studies have yielded conflicting results regarding protein intake benefits.

Purpose of the Study:

• To determine the effect of higher protein dosing compared to standard dosing in critically ill patients at high nutritional risk.
• To evaluate mortality and other clinical outcomes associated with different protein intake strategies.
• To provide evidence-based guidance for nutritional support in the ICU.

Main Methods:

• International, multicentre, pragmatic, registry-based randomized trial.
• Involved critically ill patients identified as high nutritional risk.
• Compared higher protein dosing (e.g., 2.2 g/kg/day) versus standard dosing (e.g., 1.2 g/kg/day).

Main Results:

• No significant difference in 90-day mortality between the higher protein group and the standard protein group.
• No significant differences observed in other secondary outcomes, including ICU-free days and hospital-free days.
• Higher protein administration was associated with increased incidence of new renal replacement therapy.

Conclusions:

• Higher protein dosing in critically ill patients with high nutritional risk does not improve clinical outcomes.
• Standard protein dosing appears adequate for this patient population.
• Higher protein intake may be associated with potential harm, specifically renal complications.