Use of a High-Protein Enteral Nutrition Formula to Increase Protein Delivery to Critically Ill Patients: A Randomized, Blinded, Parallel-Group, Feasibility Trial

Lee anne S. Chapple, Matthew J. Summers, Rinaldo Bellomo, Marianne J. Chapman, Andrew R. Davies, Suzie Ferrie, Mark E. Finnis, Sally Hurford, Kylie Lange, Lorraine Little, Stephanie N. O'Connor, Sandra L. Peake, Emma J. Ridley, Paul J. Young, Patricia J. Williams, Adam M. Deane, for the TARGET Investigator Collaborative and the ANZICS Clinical Trials Group

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4 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)699-709
Number of pages11
JournalJournal of Parenteral and Enteral Nutrition
Volume45
Issue number4
DOIs
Publication statusPublished - May 2021

Keywords

  • critical illness
  • enteral feeding
  • nutrition
  • protein

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