New Insight into Optimal Protein Dosing for Critically Sick Patients

How much protein is the appropriate amount for critically ill patients in intensive care? “This has been one of the burning questions in the field of clinical nutrition support,” says Penn Nursing’s Charlene W. Compher, PhD, RD, LDN, FASPEN, Professor of Nutrition Science, Director of Graduate Nutrition Programs, and an Advanced Practice Dietitian Specialist.

A paper she and colleagues published in The Lancet sheds some light. According to findings from this collaboration, which included researchers from more than a dozen institutions in seven countries, more protein than the typical dosage did not benefit these patients, and, in the case of those with acute kidney failure, it actually caused harm.

“The findings were counter to what we would’ve expected,” Compher says.

As a researcher and clinician, Compher has spent the better part of a decade trying to understand malnutrition in clinical settings. In her field, protein has been touted as an important tool to help critically ill patients maintain muscle mass and physical function and to improve clinical outcomes. Yet Compher and colleagues couldn’t say for certain whether the usual dose or a higher one was optimal—the data simply didn’t exist—so they created a clinical trial to fill that void.

They weren’t starting from scratch, however. For the past 20 years, a registry has existed where clinicians from participating sites can voluntarily add data on nutrition practices and outcomes. That’s where Compher and colleagues turned for the Effect of Higher Protein Dosing in Critically Ill Patients Trial. They formulated a protocol that would test how protein dose affected the time to discharge for critically ill patients, as well as mortality at 60 days.

Between Jan. 17, 2018, and Dec. 3, 2021, they enrolled and randomized 1,301 patients 18 years or older from 85 different intensive care units (ICUs) in 15 countries. The patients had to have been in the ICU 96 hours or less, with the expectation that they would remain on a mechanical ventilator for the next two days, at a minimum. They also had to have one of five nutritional risk factors, like low or high body mass index, malnutrition, or frailty.

This is an excerpt from a longer article that was first published in Penn Today. It was written by Michele Berger, formerly a senior science communications officer in University Communications.