Effect of high versus standard protein provision on functional recovery in people with critical illness

Population (P):

935 mechanically ventilated critically ill patients.

Intervention (I):

High protein provision at a dosage of 2.0 g/kg per day, administered via enteral feeding.

Comparator (C):

Standard protein provision at a dosage of 1.3 g/kg per day, administered via enteral feeding.

Outcome (O):

• Primary Outcome: Health-related quality of life, measured using the EQ-5D-5L health utility score at 30, 90, and 180 days post-randomization.

• Key Findings:High protein provision was associated with worse health-related quality of life compared to standard protein provision.
  Mean difference in EQ-5D-5L health utility scores: -0.05 (95% CI -0.10 to -0.01; p=0.031), favoring the standard protein group.
  
  Safety Outcomes:Mortality: No significant difference between the groups (HR 1.14, 95% CI 0.92 to 1.40; p=0.22).
  Gastrointestinal intolerance: Higher incidence in the high protein group (OR 1.76, 95% CI 1.06 to 2.92; p=0.030).
  

Study Design (S):

Double-blinded, multicentre, parallel-group, randomized controlled trial conducted in Belgium and the Netherlands.

Conclusion:

This study challenges the assumption that higher protein provision leads to improved outcomes in critically ill patients. The findings indicate that high protein provision (2.0 g/kg per day) may not only fail to enhance functional recovery but could also negatively impact health-related quality of life and increase gastrointestinal intolerance. The results suggest that standard protein provision (1.3 g/kg per day) may be more beneficial in this patient population, with fewer associated risks. These insights are crucial for optimizing nutritional management strategies in intensive care units.