Appropriate protein provision in critical illness: a systematic and narrative review

Widely varying recommendations have been published with regard to the appropriate amount of protein or amino acids to provide in critical illness. We carried out a systematic review of clinical trials that compared the metabolic or clinical effects of different protein intakes in adult critical illn...

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Bibliographic Details
Published in:The American journal of clinical nutrition 2012-09, Vol.96 (3), p.591-600
Main Authors: HOFFER, L. John, BISTRIAN, Bruce R
Format: Article
Language:English
Subjects:
Adult
Adults
Amino acids
Amino Acids - administration & dosage
Amino Acids - adverse effects
Amino Acids - metabolism
Biological and medical sciences
Clinical trials
Comparative analysis
Critical Care
Diet, Protein-Restricted - adverse effects
Dietary Proteins - administration & dosage
Dietary Proteins - adverse effects
Dietary Proteins - metabolism
Evidence-Based Medicine
Feeding. Feeding behavior
Fundamental and applied biological sciences. Psychology
Humans
Intensive Care Units
Proteins
Vertebrates: anatomy and physiology, studies on body, several organs or systems
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Summary:Widely varying recommendations have been published with regard to the appropriate amount of protein or amino acids to provide in critical illness. We carried out a systematic review of clinical trials that compared the metabolic or clinical effects of different protein intakes in adult critical illness and comprehensively reviewed all of the available evidence pertinent to the safe upper limit of protein provision in this setting. MEDLINE was searched for clinical trials published in English between 1948 and 2012 that provided original data comparing the effects of different levels of protein intake on clinically relevant outcomes and evidence pertinent to the safe upper limit of protein provision to critically ill adults. The limited amount and poor quality of the evidence preclude conclusions or clinical recommendations but strongly suggest that 2.0-2.5 g protein substrate · kg normal body weight⁻¹ · d⁻¹ is safe and could be optimum for most critically ill patients. At the present time, most critically ill adults receive less than half of the most common current recommendation, 1.5 g protein · kg⁻¹ · d⁻¹, for the first week or longer of their stay in an intensive care unit. There is an urgent need for well-designed clinical trials to identify the appropriate level of protein provision in critical illness.
ISSN:0002-9165
1938-3207
DOI:10.3945/ajcn.111.032078