ABSTRACT
BACKGROUND: Conflicting findings regarding the impact of High protein intake during the early phase in critically ill patients have been reported. Therefore, we aimed to assess the influence of higher early protein intake on the prognosis of critically ill patients. METHODS: This randomized controlled trial involved 173 critically ill patients who stayed in the Intensive Care Unit/Emergency ICU (ICU/EICU) for at least 7 days. The Low group (n = 87) and High group (n = 86) received protein supplementation of 0.8 g/kg.d and 1.5 g/kg.d, respectively, within 1-3 days of enteral nutrition (EN) initiation, with both groups transitioning to 1.5 g/kg.d on the 4th day. The serum prealbumin (PA), blood urea nitrogen/creatinine, and rectus femoris muscle thickness and cross-sectional area of all patients was measured on the 1th, 3rd, 5th, 7th day, and the day of ICU/EICU discharge. RESULTS: Patients in both Low and High groups showed no significant differences in age, APACHE II scores, or other demographic and baseline characteristics. There were also no significant differences in the primary outcome (28-day mortality rate) and secondary outcomes (incidence rate of refeeding syndrome and EN tolerance score) between the two groups. However, the Low group exhibited a significantly higher 28-day mortality rate (HR = 2.462, 95% CI: 1.021-5.936, P = 0.045) compared to High group, as determined by Cox proportional hazards models incorporating the time factor. The High group exhibited significantly shorter durations of mechanical ventilation and ICU stay compared to the Low group. Serum PA levels were higher, and rectus femoris muscle atrophy rates were lower in the High group. Furthermore, for septic patients, high protein intake significantly reduced the 28-day mortality rate despite a small sample size (n = 34). CONCLUSIONS: Our study indicates that increasing early protein intake to 1.5 g/kg.d may be safe and help improve the nutritional status and prognosis of critically ill patients. TRIAL REGISTRATION: This study was registered with the Chinese Clinical Trial Registry (ChiCTR2000039997, https://www.chictr.org.cn/ ).
ABSTRACT
OBJECTIVE: This study aimed to evaluate the efficacy of modified HuangLian JieDu decoction (MHLJDD) as a supplementary medication for early enteral nutrition in septic patients. METHODS: This study was designed as a randomized controlled preliminary study. Septic patients were randomly divided into control (treated with the base treatment) and intervention (co-treated with MHLJDD and the base treatment) groups. The primary outcomes of this study were 60-day (d) mortality rate, length of mechanical ventilation (MV), and length of stay in the intensive care unit (ICU). RESULTS: Of the 86 included patients, 44 and 42 were allocated to the intervention and control groups, respectively. Lengths of MV and ICU stay were significantly shorter in the intervention group than in the control group (10.31â ±â 3.92 d vs 8.66â ±â 2.84 d, Pâ =â .028; and 11.88â ±â 5.25 d vs 10.41â ±â 3.14 d, Pâ =â .029; respectively). However, the difference in 60-d mortality rate between the 2 groups was not statistically significant (20.45% vs 38.10%, Pâ =â .071). The enteral-nutrition tolerance score of the control group was higher than that of the intervention group (6.81â ±â 4.28 vs 4.68â ±â 4.04, Pâ =â .020). Incidence of hyperglycemia and gastric retention (gastric residual volumeâ >â 250 mL) was higher in the control group than in the intervention group (59.52% vs 29.55%, Pâ =â .005; and 28.57% vs 11.36%, Pâ =â .020, respectively). CONCLUSIONS: MHLJDD can shorten the MV and ICU stay of septic patients.
