Protein delivery in mechanically ventilated adults in Australia and New Zealand: current practice

Tejaswini Arunachala Murthy; Rinaldo Bellomo; Marianne J Chapman; Adam M Deane; Suzie Ferrie; Mark E Finnis; Sally Hurford; Stephanie N O'Connor; Sandra L Peake; Matthew J Summers; Patricia J Williams; Paul J Young; Lee-Anne S Chapple; TARGET Protein Management Committee

doi:10.51893/2021.4.OA3

Protein delivery in mechanically ventilated adults in Australia and New Zealand: current practice

Crit Care Resusc. 2023 Oct 18;23(4):386-393. doi: 10.51893/2021.4.OA3. eCollection 2021 Dec 6.

Authors

Tejaswini Arunachala Murthy^{1

2}, Rinaldo Bellomo^{3

4

5

6}, Marianne J Chapman^{1

2

7

4}, Adam M Deane^{5

6}, Suzie Ferrie⁸, Mark E Finnis^{1

2}, Sally Hurford⁹, Stephanie N O'Connor^{1

2}, Sandra L Peake^{2

4

10}, Matthew J Summers^{1

2}, Patricia J Williams^{2

4

10}, Paul J Young^{4

5

9

11}, Lee-Anne S Chapple^{1

2

7}; TARGET Protein Management Committee

Affiliations

¹ Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
² Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
³ Intensive Care Unit, Austin Health, Melbourne, VIC, Australia.
⁴ Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia.
⁵ Department of Critical Care, University of Melbourne, Melbourne, VIC, Australia.
⁶ Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
⁷ National Health and Medical Research Council of Australia, Centre for Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, SA, Australia.
⁸ Department of Nutrition & Dietetics, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
⁹ Medical Research Institute of New Zealand, Wellington, New Zealand.
¹⁰ Department of Intensive Care Medicine,Queen Elizabeth Hospital, Adelaide, SA, Australia.
¹¹ Intensive Care Unit, Wellington Hospital, Wellington, New Zealand.

Abstract

Objective: To quantify current protein prescription and delivery in critically ill adults in Australia and New Zealand and compare it with international guidelines. Design: Prospective, multicentre, observational study. Setting: Five intensive care units (ICUs) across Australia and New Zealand. Participants: Mechanically ventilated adults who were anticipated to receive enteral nutrition for ≥ 24 hours. Main outcome measures: Baseline demographic and nutrition data in ICU, including assessment of requirements, prescription and delivery of enteral nutrition, parenteral nutrition and protein supplementation, were collected. The primary outcome was enteral nutrition protein delivery (g/kg ideal body weight [IBW] per day). Data are reported as mean ± standard deviation or n (%). Results: 120 patients were studied (sex, 60% male; mean age, 59 ± 16 years; mean admission APACHE II score, 20 ± 8). Enteral nutrition was delivered on 88%, parenteral nutrition on 6.8%, and protein supplements on 0.3% of 1156 study days. For the 73% (88/120) of patients who had a nutritional assessment, the mean estimated protein requirements were 99 ± 22 g/day (1.46 ± 0.55 g/kg IBW per day). The mean daily protein delivery was 54 ± 23 g (0.85 ± 0.35 g/kg IBW per day) from enteral nutrition and 56 ± 23 g (0.88 ± 0.35 g/kg IBW per day) from all sources (enteral nutrition, parenteral nutrition, protein supplements). Protein delivery was ≥ 1.2 g/kg IBW per day on 29% of the total study days per patient. Conclusions: Protein delivery as a part of current usual care to critically ill adults in Australia and New Zealand remains below that recommended in international guidelines.