Critical Illness

CI: Protein Needs (2007)

• Assessment
  What level of protein intake or what protein delivery is associated with improvements in mortality?

  • Conclusion
    To date, no studies were found in generalized critical care populations that demonstrated a significant difference in mortality based on level of protein intake or delivery. In critically ill patients undergoing continuous renal replacement therapy, a single study indicates that protein intake > 2.0 g per kg per day is more likely to promote positive N balance (P=0.0001).  And, while a more positive N balance is associated with decreased mortality, a higher protein intake was not associated with mortality.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What level of protein intake or what protein delivery is associated with improvements in mortality?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Scheinkestel CD, Kar L, Marshall K, Bailey M, Davies A, Nyulasi I, Tuxen DV. Prospective randomized trial to assess caloric and protein needs of critically ill, anuric, ventilated patients requiring continuous renal replacement therapy. Nutrition 2003;19(11-12):909-16.
  • Search Plan and Results: CI: Protein Intake and Clinical Outcomes 2007
     
  What level of protein intake or what protein delivery is associated with improvements in rate of infectious complications?

  • Conclusion
    To date, adequately powered studies have not been conducted to demonstrate a significant difference in rate of infectious complications when comparing critically ill patients with positive or negative N balance.
  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CI: Protein Intake and Clinical Outcomes 2007
     
  What level of protein intake or what protein delivery is associated with improvements in length of hospital stay?

  • Conclusion
    To date, no studies were found that demonstrated a significant difference in LOS or ICU length of stay based on level of protein intake or protein delivery. In critically ill patients undergoing continuous renal replacement therapy, a single study indicates that protein intake > 2.0 g per kg per day is more likely to promote positive N balance (p=.0001), however, LOS was not related to N balance.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: What level of protein intake or what protein delivery is associated with improvements in length of hospital stay?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Scheinkestel CD, Kar L, Marshall K, Bailey M, Davies A, Nyulasi I, Tuxen DV. Prospective randomized trial to assess caloric and protein needs of critically ill, anuric, ventilated patients requiring continuous renal replacement therapy. Nutrition 2003;19(11-12):909-16.
  • Search Plan and Results: CI: Protein Intake and Clinical Outcomes 2007
     
  What level of protein intake or what protein delivery is associated with improvements in days on mechanical ventilation?

  • Conclusion
    To date, adequately powered studies have not been conducted to demonstrate a significant difference in days on mechanical ventilation when comparing critically ill patients with positive or negative N balance.
  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CI: Protein Intake and Clinical Outcomes 2007
     
  What level of protein intake or what protein delivery is associated with improvements in cost of medical care?

  • Conclusion
    To date, adequately powered studies have not been conducted to demonstrate a significant difference in cost of medical care when comparing critically ill patients with positive or negative N balance.
  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Search Plan and Results: CI: Protein Intake and Clinical Outcomes 2007