Protein metabolism in critical illness

Chapple, Lee‐anne S.; Gassel, Rob J J van; Rooyackers, Olav

doi:10.1097/mcc.0000000000000959

Cited by 13 publications

(13 citation statements)

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“…A possible reason for these divergent findings may be that the protein intake was explored overall during the ICU stay, rather than focusing on the early phase as we did. Yet, early acute-illness-associated stress impairs protein–energy metabolism and its responsiveness to exogenous nutrients [ 52 , 53 ]. Koekkoek et al reported, in a recent retrospective study, a time-dependent association of protein intake with mortality: before day 3 in the ICU, a protein intake superior to 0.8 g/kg/day was associated with significantly higher 6-month mortality; after D3, a progressive increase protein provision was associated with an improvement in patients outcomes [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

et al. 2023

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Background Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. Methods The ‘French-Speaking ICU Nutritional Survey’ (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. Results During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23–2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00–1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01–1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98–1.11). Conclusions In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.

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Section: Discussionmentioning

confidence: 99%

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

et al. 2023

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“…More recently, there has been increasing interest in the uptake and metabolism of dietary protein. Dietary protein has gained interest because of its potential to attenuate skeletal muscle wasting during critical illness and improve functional recovery of patients, though robust prospective evidence on this is still lacking [23]. Chapple et al [24 ▪▪ ] recently investigated protein digestion and absorption rates and the subsequent contribution of dietary protein to skeletal muscle protein synthesis in critical illness.…”

Section: Gastrointestinal Dysfunction and Nutrient Handlingmentioning

confidence: 99%

Nutritional strategies during gastrointestinal dysfunction

Gassel

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2023

Current Opinion in Critical Care

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Purpose of review Gastrointestinal (GI) dysfunction is common among critically ill patients and is associated with poor outcomes. In particular, nutrient delivery can be impaired in patients with GI dysfunction and pose a significant challenge to clinicians in daily clinical practice. This review aims to summarize the impact of GI dysfunction on nutrition therapy during critical illness and provide an update on recent advances in nutritional strategies during gastrointestinal dysfunction. Recent findings Although prognostic gastrointestinal dysfunction scoring systems exist, a lack of clear, uniform definitions of GI dysfunction limits diagnosis and subsequent adequate treatment. Recent studies have further investigated separate components of GI dysfunction in ICU patients, including the role of altered GI motility, nutrient digestion and absorption and the metabolic consequences of gut dysfunction. Various strategies to improve nutrient delivery are discussed. However, the evidence supporting their routine use is sometimes lacking. Summary GI dysfunction frequently occurs during critical illness and negatively affects nutrition therapy. Strategies to improve nutrient delivery during GI dysfunction are available, though more research into the diagnosis and pathophysiology of GI dysfunction will likely further improve patient outcomes.

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“…Several factors are known to increase net muscle protein breakdown including inflammation, oxidative stress, immobilization, and corticosteroid use [39,49,[55][56][57]. Critically ill patients also experience insulin resistance and anabolic resistance, which is a blunted anabolic response to amino acids characterized by failure to stimulate nutrient uptake and muscle protein synthesis and inhibit muscle protein breakdown [58,59]. Muscle atrophy frequently occurs in the ICU with the steepest rate of loss occurring within the first two weeks of ICU admission [60][61][62][63][64].…”

Section: The Need For Nutrition In Post-icu Rehabilitationmentioning

confidence: 99%

The role of nutrition rehabilitation in the recovery of survivors of critical illness: underrecognized and underappreciated

2022

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Many survivors of critical illness face significant physical and psychological disability following discharge from the intensive care unit (ICU). They are often malnourished, a condition associated with poor outcomes, and nutrition remains problematic particularly in the early phases of ICU recovery. Yet nutrition rehabilitation, the process of restoring or optimizing nutritional status following illness, is seldom prioritized, possibly because it is an underrecognized and underappreciated area in critical care rehabilitation and research. To date, 16 original studies have been published where one of the objectives includes measurement of indices relating to nutritional status (e.g., nutrition intake or factors impacting nutrition intake) in ICU survivors. The primary aim of this narrative review is to provide a comprehensive summary of key themes arising from these studies which form the basis of our current understanding of nutritional recovery and rehabilitation in ICU survivors. ICU survivors face a multitude of barriers in achieving optimal nutrition that are of physiological (e.g., poor appetite and early satiety), functional (e.g., dysphagia, reduced ability to feed independently), and psychological (e.g., low mood, body dysmorphia) origins. Organizational-related barriers such as inappropriate feeding times and meal interruptions frequently impact an ICU survivor’s ability to eat. Healthcare providers working on wards frequently lack knowledge of the specific needs of recovering critically ill patients which can negatively impact post-ICU nutrition care. Unsurprisingly, nutrition intake is largely inadequate following ICU discharge, with the largest deficits occurring in those who have had enteral nutrition prematurely discontinued and rely on an oral diet as their only source of nutrition. With consideration to themes arising from this review, pragmatic strategies to improve nutrition rehabilitation are explored and directions for future research in the field of post-ICU nutrition recovery and rehabilitation are discussed. Given the interplay between nutrition and physical and psychological health, it is imperative that enhancing the nutritional status of an ICU survivor is considered when developing multidisciplinary rehabilitation strategies. It must also be recognized that dietitians are experts in the field of nutrition and should be included in stakeholder meetings that aim to enhance ICU rehabilitation strategies and improve outcomes for survivors of critical illness.

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Protein metabolism in critical illness

Cited by 13 publications

References 47 publications

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study

Nutritional strategies during gastrointestinal dysfunction

The role of nutrition rehabilitation in the recovery of survivors of critical illness: underrecognized and underappreciated

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