Augmented Enteral Protein During Critical Illness: The TARGET Protein Randomized Clinical Trial

Area of Science:

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

Background:

• Current guidelines suggest increasing protein intake for critically ill patients.
• However, the actual impact of augmented enteral protein on patient outcomes remains unclear.
• This uncertainty necessitates rigorous clinical trials to guide practice.

Purpose of the Study:

• To investigate whether augmenting enteral protein intake in critically ill patients improves outcomes.
• Specifically, to determine if higher protein levels increase the number of days alive and free from hospitalization at day 90.
• To evaluate the effect on various secondary clinical outcomes.

Main Methods:

• A cluster randomized, crossover, open-label trial was conducted across 8 ICUs in Australia and New Zealand.
• Critically ill patients receiving enteral nutrition were assigned to either augmented protein (100 g/L) or usual protein (63 g/L) formulae sequentially over 12 months.
• The primary outcome measured was days alive and free from the index hospital at day 90, with multiple secondary outcomes assessed.

Main Results:

• A total of 3397 patients were included in the trial.
• The median number of days alive and free from the index hospital at day 90 was similar between groups (62 days augmented vs. 64 days usual).
• No significant differences were observed in survival at day 90 or in key secondary outcomes like ventilation duration, ICU/hospital length of stay, or rates of tracheostomy and kidney replacement therapy.

Conclusions:

• Augmenting enteral protein in critically ill patients did not lead to a significant improvement in the primary outcome of days alive and free from hospitalization at day 90.
• The findings suggest that current recommendations for increased protein may not translate to improved clinical outcomes in this patient population.
• Further research may be needed to identify specific subgroups of critically ill patients who might benefit from augmented protein intake.