Protein intake deficiency in critically ill children with respiratory insufficiency: A call to action?

Melro, Erica Carolina; Lima, A.E.D.S.; Springer, Alice Missagia de Mattos; Souza, Tiago Henrique de; Nogueira, Roberto José Negrão

doi:10.1016/j.clnesp.2020.03.018

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…In a prospective observational cohort study, the median protein adequacy in critically ill children with respiratory failure was 56% with a median protein intake of 0.84 g/kg/ day. Despite this protein intake being higher than other recently published cohorts, it remains less than the currently recommended protein requirement of 1.5 g/kg/day [15]. Therefore, the optimal amount of protein that can be safely delivered and that will improve patient outcomes remains unknown.…”

Section: Timing and Macronutrient Prescriptionmentioning

confidence: 84%

“…Delivering 60% of estimated protein requirement in critically ill children has been associated with improved outcomes, including survival [14]. Achieving protein adequacy remains one of the most challenging aspects of nutrition delivery [15]. In a prospective observational cohort study, the median protein adequacy in critically ill children with respiratory failure was 56% with a median protein intake of 0.84 g/kg/ day.…”

Section: Timing and Macronutrient Prescriptionmentioning

confidence: 99%

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Challenges and advances in nutrition for the critically ill child

Albert

Martinez

2022

Current Opinion in Critical Care

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Purpose of reviewMalnutrition remains prevalent in critically ill children and is associated with worse clinical outcomes. Conversely, nutrition provision has been associated with improved survival. Nutritional challenges must be addressed to guide best nutrition practices for the critically ill child. In this narrative review, we summarize findings from research published between July 2020 and January 2022 on nutrition in critically ill children. Findings from these articles build on previous work to guide next steps in both research and clinical practice in this cohort.Recent findingsA comprehensive literature review was performed. We identified the following common themes for research published between July 2020 and January 2022-metabolism, enteral nutrition, including timing, dosing, protein prescription and delivery in special populations, gastrointestinal function, and enteral nutrition adjunctive therapies.SummaryResearch continues to support early initiation and advancement of enteral nutrition. Achieving nutritional adequacy is challenging, but research associated with the timing and dosing of enteral nutrition, alternative methods of enteral nutrition delivery and the use of adjuncts are expanding our understanding of best practices for this cohort. Areas for further research continue to be the use of measured energy requirements, protein dosing and inclusion of functional outcomes to assess the benefit of nutritional interventions.

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Section: Timing and Macronutrient Prescriptionmentioning

confidence: 84%

Section: Timing and Macronutrient Prescriptionmentioning

confidence: 99%

Challenges and advances in nutrition for the critically ill child

Albert

Martinez

2022

Current Opinion in Critical Care

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“…This is observed in other similar studies where patients do not meet the requirements and do not receive parenteral nutrition. 18 , 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina

Chapela¹,

Manzanares²,

Quesada³

et al. 2023

Endocrinología, Diabetes y Nutrición (English ed.)

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“…8 Inadequate nutritional provision has been reported in several PICU studies, with reported rates of protein inadequacy ranging from 37% to 87%. [9][10][11] Inadequate protein intake is associated with poor clinical outcomes in critically ill children. In a large, multicentre cohort study, protein intake ≤60% of the prescribed amount was associated with greater odds of mortality compared with those that received >60% of…”

Section: Introduction Background and Rationalementioning

confidence: 99%

Protein supplementation versus standard feeds in underweight critically ill children: a pilot dual-centre randomised controlled trial protocol

Wong

Ong

et al. 2022

BMJ Open

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IntroductionProtein–energy malnutrition, increased catabolism and inadequate nutritional support leads to loss of lean body mass with muscle wasting and delayed recovery in critical illness. However, there remains clinical equipoise regarding the risks and benefits of protein supplementation. This pilot trial will determine the feasibility of performing a larger multicentre trial to determine if a strategy of protein supplementation in critically ill children with body mass index (BMI) z-score ≤−2 is superior to standard enteral nutrition in reducing the length of stay in the paediatric intensive care unit (PICU).Methods and analysisThis is a randomised controlled trial of 70 children in two PICUs in Singapore. Children with BMI z-score ≤−2 on PICU admission, who are expected to require invasive mechanical ventilation for more than 48 hours, will be randomised (1:1 allocation) to protein supplementation of ≥1.5 g/kg/day in addition to standard nutrition, or standard nutrition alone for 7 days after enrolment or until PICU discharge, whichever is earlier. Feasibility outcomes for the trial include effective screening, satisfactory enrolment rate, timely protocol implementation (within first 72 hours) and protocol adherence. Secondary outcomes include mortality, PICU length of stay, muscle mass, anthropometric measurements and functional outcomes.Ethics and disseminationThe trial protocol was approved by the institutional review board of both participating centres (Singhealth Centralised Institutional Review Board and National Healthcare Group Domain Specific Review Board) under the reference number 2020/2742. Findings of the trial will be disseminated through peer-reviewed journals and scientific conferences.Trial registration numberNCT04565613.

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Protein intake deficiency in critically ill children with respiratory insufficiency: A call to action?

Cited by 7 publications

References 26 publications

Challenges and advances in nutrition for the critically ill child

Challenges and advances in nutrition for the critically ill child

Nutrition intake in critically ill patients with coronavirus disease (COVID-19): A nationwide, multicentre, observational study in Argentina

Protein supplementation versus standard feeds in underweight critically ill children: a pilot dual-centre randomised controlled trial protocol

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