Optimal protein requirements during the first 2 weeks after the onset of critical illness.
Crit Care Med
; 26(9): 1529-35, 1998 Sep.
Article
in En
| MEDLINE
| ID: mdl-9751589
ABSTRACT
OBJECTIVE:
To obtain optimal protein requirements in critically ill sepsis or trauma patients during the first 2 wks after admission to the intensive care unit.DESIGN:
Retrospective study.SETTING:
Department of critical care medicine at a teaching hospital. PATIENTS Immediate posttrauma patients or severely septic patients.INTERVENTIONS:
In vivo neutron activation analysis was used to measure changes in total body protein over a 10-day period which began as soon as the patients were hemodynamically stable. The patients (trauma, n=18; sepsis, n=5) were divided into three groups according to the average daily protein intakes. Because the patients were overhydrated (approximately 10 L) and had variable amounts of body fat, the protein intakes were indexed to normally hydrated (corrected) fat-free mass (FFMc) Groups A, B, and C received an average of 1.1, 1.5, and 1.9 g/kg FFMc/day protein, respectively. MEASUREMENTS AND MAINRESULTS:
Overall, the average loss of total body protein was 1.2=0.7 (SD) kg. Changes in total body protein were significantly (p=.011) different between the three groups. The loss of body protein was significantly more in group A compared with groups B (p=.013) and C (p=.023). When the protein intake was increased from 1.1 g/kg FFMc/day to 1.5 g/kg FFMc/day, protein loss was halved. Further increase in protein intake up to 1.9 g/kg FFMc/day resulted in no further improvement. An intake of 1.5 g/kg FFMc/day was equivalent to 1.0 g/day/kg of body weight measured at the beginning of the study.CONCLUSIONS:
Current recommended protein requirements of 1.2 to 2.0 g/kg of body weight/day are excessive if they are indexed to the body weight measured soon after the onset of critical illness. Because individual patients have varying degrees of overhydration early in the illness onset, we suggest that the intensivist should obtain information on preillness body weight and prescribe 1.2g of protein/kg body weight/day. If information is not available, 1.0g of protein/day/kg of measured body weight will give a fair approximation to optimal protein requirements.
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Collection:
01-internacional
Database:
MEDLINE
Main subject:
Wounds and Injuries
/
Dietary Proteins
/
Critical Illness
/
Bacteremia
/
Critical Care
Type of study:
Observational_studies
Limits:
Adolescent
/
Adult
/
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Language:
En
Journal:
Crit Care Med
Year:
1998
Document type:
Article
Affiliation country:
Nueva Zelanda