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Protein delivery in mechanically ventilated adults in Australia and New Zealand: current practice
Tejaswini Arunachala Murthy, Rinaldo Bellomo, Marianne J Chapman, Adam M Deane, Suzie Ferrie, Mark E Finnis, Sally Hurford, Stephanie N O'Connor, Sandra L Peake, Matthew J Summers, Patricia J Williams, Paul J Young, Lee-anne S Chapple, for the TARGET Protein Management Committee
Crit Care Resusc 2021; 23 (4): 386-393
- Tejaswini Arunachala Murthy 1, 2
- Rinaldo Bellomo 3, 4, 5, 6
- Marianne J Chapman 1, 2, 4, 7
- Adam M Deane 5, 6
- Suzie Ferrie 8
- Mark E Finnis 1, 2
- Sally Hurford 9
- Stephanie N O'Connor 1, 2
- Sandra L Peake 2, 4, 10
- Matthew J Summers 1, 2
- Patricia J Williams 2, 4, 10
- Paul J Young 4, 5, 9, 11
- Lee-anne S Chapple 1, 2, 7
- for the TARGET Protein Management Committee 12
OBJECTIVE: To quantify current protein prescription and delivery in critically ill adults in Australia and New Zealand and compare it with international guidelines.
DESIGN: Prospective, multicentre, observational study.
SETTING: Five intensive care units (ICUs) across Australia and New Zealand.
PARTICIPANTS: Mechanically ventilated adults who were anticipated to receive enteral nutrition for ≥ 24 hours.
MAIN OUTCOME MEASURES: Baseline demographic and nutrition data in ICU, including assessment of requirements, prescription and delivery of enteral nutrition, parenteral nutrition and protein supplementation, were collected. The primary outcome was enteral nutrition protein delivery (g/kg ideal body weight [IBW] per day). Data are reported as mean ± standard deviation or n (%).
RESULTS: 120 patients were studied (sex, 60% male; mean age, 59 ± 16 years; mean admission APACHE II score, 20 ± 8). Enteral nutrition was delivered on 88%, parenteral nutrition on 6.8%, and protein supplements on 0.3% of 1156 study days. For the 73% (88/120) of patients who had a nutritional assessment, the mean estimated protein requirements were 99 ± 22 g/day (1.46 ± 0.55 g/kg IBW per day). The mean daily protein delivery was 54 ± 23 g (0.85 ± 0.35 g/kg IBW per day) from enteral nutrition and 56 ± 23 g (0.88 ± 0.35 g/kg IBW per day) from all sources (enteral nutrition, parenteral nutrition, protein supplements). Protein delivery was ≥ 1.2 g/kg IBW per day on 29% of the total study days per patient.
CONCLUSIONS: Protein delivery as a part of current usual care to critically ill adults in Australia and New Zealand remains below that recommended in international guidelines.
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In addition, for patients who had a nutritional assessment, the daily protein deficit was calculated as the total protein received from enteral nutrition, parenteral nutrition, and protein supplements subtracted from the calculated daily protein requirements. Daily protein deficits were summed to determine the total protein deficit over the study period.
The mean amount of protein delivered to patients per day from all sources was 56 ± 23 g/day (0.88 ± 0.35 g/kg IBW per day) (Table 2). On average per patient, mean daily protein delivery was ≥ 1.2 g/kg IBW per day on 29% of the study days. The mean daily protein delivered in g/kg IBW per day from day 1 to day 21 is presented in Figure 1. The mean calorie delivery from all sources was 1148 ± 451 kcal/day (18.0 ± 6.9 kcal/kg IBW per day) (Table 2).