Use of a High-Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel-Group, Feasibility Trial
AuthorChapple, L-AS; Summers, MJ; Bellomo, R; Chapman, MJ; Davies, AR; Ferrie, S; Finnis, ME; Hurford, S; Lange, K; Little, L; ...
Source TitleJournal of Parenteral and Enteral Nutrition
AffiliationMedicine and Radiology
Medicine and Radiology
Document TypeJournal Article
CitationsChapple, L. -A. S., Summers, M. J., Bellomo, R., Chapman, M. J., Davies, A. R., Ferrie, S., Finnis, M. E., Hurford, S., Lange, K., Little, L., O'Connor, S. N., Peake, S. L., Ridley, E. J., Young, P. J., Williams, P. J. & Deane, A. M. (2020). Use of a High-Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel-Group, Feasibility Trial. JOURNAL OF PARENTERAL AND ENTERAL NUTRITION, 45 (4), pp.699-709. https://doi.org/10.1002/jpen.2059.
Access StatusThis item is embargoed and will be available on 2021-12-09
BACKGROUND: International guidelines recommend critically ill adults receive more protein than most receive. We aimed to establish the feasibility of a trial to evaluate whether feeding protein to international recommendations would improve outcomes, in which 1 group received protein doses representative of international guideline recommendations (high protein) and the other received doses similar to usual practice. METHODS: We conducted a prospective, randomized, blinded, parallel-group, feasibility trial across 6 intensive care units. Critically ill, mechanically ventilated adults expected to receive enteral nutrition (EN) for ≥2 days were randomized to receive EN containing 63 or 100 g/L protein for ≤28 days. Data are mean (SD) or median (interquartile range). RESULTS: The recruitment rate was 0.35 (0.13) patients per day, with 120 patients randomized and data available for 116 (n = 58 per group). Protein delivery was greater in the high-protein group (1.52 [0.52] vs 0.99 [0.27] grams of protein per kilogram of ideal body weight per day; difference, 0.53 [95% CI, 0.38-0.69] g/kg/d protein), with no difference in energy delivery (difference, -26 [95% CI, -190 to 137] kcal/kg/d). There were no between-group differences in the duration of feeding (8.7 [7.3] vs 8.1 [6.3] days), and blinding of the intervention was confirmed. There were no differences in clinical outcomes, including 90-day mortality (14/55 [26%] vs 15/56 [27%]; risk difference, -1.3% [95% CI, -17.7% to 15.0%]). CONCLUSION: Conducting a multicenter blinded trial is feasible to compare protein delivery at international guideline-recommended levels with doses similar to usual care during critical illness.
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