Danielle E Bear, Matthew J Summers, Lee-Anne S Chapple
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Dietary protein in the ICU in relation to health outcomes.
Purpose of review: Critical care nutrition guidelines recommend provision of higher protein doses than recommended in health. These recommendations have been predominately based on lower quality evidence and physiological rationale that greater protein doses may attenuate the significant muscle loss observed in critically ill patients. This review discusses the mechanistic action of protein in the critically ill, details results from recent trials on health outcomes, discusses considerations for interpretation of trial results, and provides an overview of future directions.
Recent findings: Two recent large clinical trials have investigated different protein doses and the effect on clinical outcome. Important findings revealed potential harm in certain sub-groups of patients. This harm must be balanced with the potential for beneficial effects on muscle mass and physical function given that two recent systematic reviews with meta-analyses demonstrated attenuation of muscle loss with higher protein doses. Utilizing biological markers such as urea: creatinine ratio or urea levels may prove useful in monitoring harm from higher protein doses.
Summary: Future research should focus on prospectively investigating biological signatures of harm as well as taking into the consideration elements that will likely enhance the effectiveness of protein dose.
期刊介绍:
A high impact review journal which boasts an international readership, Current Opinion in Clinical Nutrition and Metabolic Care offers a broad-based perspective on the most recent and exciting developments within the field of clinical nutrition and metabolic care. Published bimonthly, each issue features insightful editorials and high quality invited reviews covering two or three key disciplines which include protein, amino acid metabolism and therapy, lipid metabolism and therapy, nutrition and the intensive care unit and carbohydrates. Each discipline introduces world renowned guest editors to ensure the journal is at the forefront of knowledge development and delivers balanced, expert assessments of advances from the previous year.