How Much and What Type of Protein Should a Critically Ill Patient Receive?

Juan B. Ochoa Gautier, Robert Martindale, Saúl J. Rugeles, Ryan T. Hurt, Beth Taylor, Daren K. Heyland, Stephen A. McClave

Research output: Contribution to journalArticle

10 Scopus citations

Abstract

Protein loss, manifested as loss of muscle mass, is observed universally in all critically ill patients. Depletion of muscle mass is associated with impaired function and poor outcomes. In extreme cases, protein malnutrition is manifested by respiratory failure, lack of wound healing, and immune dysfunction. Protecting muscle loss focused initially on meeting energy requirements. The assumption was that protein was being used (through oxidation) as an energy source. In healthy individuals, small amounts of glucose (approximately 400 calories) protect muscle loss and decrease amino acid oxidation (protein-sparing effect of glucose). Despite expectations of the benefits, the high provision of energy (above basal energy requirements) through the delivery of nonprotein calories has failed to demonstrate a clear benefit at curtailing protein loss. The protein-sparing effect of glucose is not clearly observed during illness. Increasing protein delivery beyond the normal nutrition requirements (0.8 g/k/d) has been investigated as an alternative solution. Over a dozen observational studies in critically ill patients suggest that higher protein delivery is beneficial at protecting muscle mass and associated with improved outcomes (decrease in mortality). Not surprisingly, new Society of Critical Care Medicine/American Society for Parenteral and Enteral Nutrition guidelines and expert recommendations suggest higher protein delivery (>1.2 g/kg/d) for critically ill patients. This article provides an introduction to the concepts that delineate the basic principles of modern medical nutrition therapy as it relates to the goal of achieving an optimal management of protein metabolism during critical care illness, highlighting successes achieved so far but also placing significant challenges limiting our success in perspective.

Original languageEnglish (US)
Pages (from-to)6S-14S
JournalNutrition in Clinical Practice
Volume32
Issue number1_suppl
DOIs
StatePublished - Apr 1 2017

    Fingerprint

Keywords

  • amino acid imbalance
  • anabolism
  • catabolism
  • critical illness
  • nutritional support
  • protein
  • protein sparing effect of glucose

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Ochoa Gautier, J. B., Martindale, R., Rugeles, S. J., Hurt, R. T., Taylor, B., Heyland, D. K., & McClave, S. A. (2017). How Much and What Type of Protein Should a Critically Ill Patient Receive? Nutrition in Clinical Practice, 32(1_suppl), 6S-14S. https://doi.org/10.1177/0884533617693609