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01-12-2021 | Nutrition | Research

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

Authors: Zheng-Yii Lee, Cindy Sing Ling Yap, M. Shahnaz Hasan, Julia Patrick Engkasan, Mohd Yusof Barakatun-Nisak, Andrew G. Day, Jayshil J. Patel, Daren K. Heyland

Published in: Critical Care | Issue 1/2021

Abstract

Background

The optimal protein dose in critical illness is unknown. We aim to conduct a systematic review of randomized controlled trials (RCTs) to compare the effect of higher versus lower protein delivery (with similar energy delivery between groups) on clinical and patient-centered outcomes in critically ill patients.

Methods

We searched MEDLINE, EMBASE, CENTRAL and CINAHL from database inception through April 1, 2021.We included RCTs of (1) adult (age ≥ 18) critically ill patients that (2) compared higher vs lower protein with (3) similar energy intake between groups, and (4) reported clinical and/or patient-centered outcomes. We excluded studies on immunonutrition. Two authors screened and conducted quality assessment independently and in duplicate. Random-effect meta-analyses were conducted to estimate the pooled risk ratio (dichotomized outcomes) or mean difference (continuous outcomes).

Results

Nineteen RCTs were included (n = 1731). Sixteen studies used primarily the enteral route to deliver protein. Intervention was started within 72 h of ICU admission in sixteen studies. The intervention lasted between 3 and 28 days. In 11 studies that reported weight-based nutrition delivery, the pooled mean protein and energy received in higher and lower protein groups were 1.31 ± 0.48 vs 0.90 ± 0.30 g/kg and 19.9 ± 6.9 versus 20.1 ± 7.1 kcal/kg, respectively. Higher vs lower protein did not significantly affect overall mortality [risk ratio 0.91, 95% confidence interval (CI) 0.75–1.10, p = 0.34] or other clinical or patient-centered outcomes. In 5 small studies, higher protein significantly attenuated muscle loss (MD −3.44% per week, 95% CI −4.99 to −1.90; p < 0.0001).

Conclusion

In critically ill patients, a higher daily protein delivery was not associated with any improvement in clinical or patient-centered outcomes. Larger, and more definitive RCTs are needed to confirm the effect of muscle loss attenuation associated with higher protein delivery.

PROSPERO registration number: CRD42021237530

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Title: The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials
Authors: Zheng-Yii Lee
Cindy Sing Ling Yap
M. Shahnaz Hasan
Julia Patrick Engkasan
Mohd Yusof Barakatun-Nisak
Andrew G. Day
Jayshil J. Patel
Daren K. Heyland
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Nutrition
Published in: Critical Care / Issue 1/2021
Electronic ISSN: 1364-8535
DOI: https://doi.org/10.1186/s13054-021-03693-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The effect of higher versus lower protein delivery in critically ill patients: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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