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The challenge of meeting protein requirements in critically ill patients in the COVID era
Clinical Nutrition ESPEN ; 48:515-516, 2022.
Article in English | EMBASE | ID: covidwho-2003970
ABSTRACT
Critically ill patients often face progressive and rapid losses of body and muscle mass due to hypermetabolism and increased protein catabolism. Certain population groups (such as obese patients or those requiring Continuous Renal Replacement Therapy (CRRT) require a higher protein provision as advised by both ASPEN1 and ESPEN2. Furthermore, critically ill patients often receive significant energy provision from non-nutritional sources such as propofol. As a consequence, calorie provision via enteral feed is commonly restricted to avoid overfeeding, and protein provision to the patient is further compromised. Retrospective data was collected for 58 patients who were either confirmed or suspected of COVID-19 and admitted to the Intensive Care Unit (ICU) during April 2020. 31% (n=18) of patients were unable to meet their protein requirements from the feed formula alone, based on initial dietetic assessment. Recommended protein requirements were not achieved in any patients who were obese (n=10;defined as BMI ≥30 kg/m2) or receiving CRRT (n=6). The maximum protein provision for obese patients was 1.5g/kg IBW and 1.6g/kg for patients receiving CRRT. The situation was exacerbated for patients receiving high dose propofol (defined as >10 ml/hr), where protein provision decreased to 0.8 – 1.2g/kg and 1.1 – 1.3g/kg respectively. [Formula presented] In the non-obese, non-CRRT ICU population, the available enteral feeding regimes were appropriate to meet the majority of patientsprotein requirements (as shown in Figure 1). However the review almost certainly overestimates protein provision, as percentage feed delivery was not assessed and the results assume 100% feed delivery. We know from previous audits on our unit that feed delivery is often <80% of target, and although this review was based on COVID-19 patients, the ‘typical’ patients in ICU often have specific nutrition requirements, which includes high protein. The challenges faced during COVID-19 has raised awareness of the importance of protein delivery in ICU and our review highlights the need to continually monitor and augment protein delivery in critically ill patients. The findings support the need for a high protein supplement in specific population groups;particularly those who may be obese, require CRRT or are receiving high dose propofol in an ICU setting. 1 McClave S A, Taylor B E, Martindale R G et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J Parenter Enteral Nutr 2016;40(2) 159-211. 2 Singer P, Blaser A R, Berger M M et al. ESPEN Guideline on clinical nutrition in the intensive care unit Clin Nut 2019;38 48-79
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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Clinical Nutrition ESPEN Year: 2022 Document Type: Article

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Full text: Available Collection: Databases of international organizations Database: EMBASE Language: English Journal: Clinical Nutrition ESPEN Year: 2022 Document Type: Article