None listed
Conditions
Brief summary
Patients admitted to ICU often suffer from muscle wasting and ICU acquired weakness associated with complications such as reduced mobilisation, respiratory weakness requiring prolonged ventilatory support, and prolonged ICU and hospital length of stay (LOS). There is renewed interest in provision of more protein, as this may increase muscle synthesis and thus improve functional recovery. While international recommendations encourage providing more protein, this is not yet supported by high quality evidence. Previous data from a randomised controlled trial conducted > 10 years ago, as well as survey data from our region, suggests that usual practice is to deliver much less than that recommended by international guidelines. Our group has planned a trial to answer the question whether greater protein doses can improve survival and patient recovery compared to current practice. However, to ensure the standard care arm constitutes true current practice, we need to first quantify how much protein patients in Australia and New Zealand actually receive. We plan to conduct an observational study evaluating current practice. One hundred and twenty patients will be included consecutively across 6 sites and protein delivery evaluated.
Interventions
Data will be collected for all eligible patients as part of standard clinical practice. Both protein prescription and delivery will be collected while the patient is receiving enteral nutrition (EN), up to 28 days, until the patient is discharged from ICU, or dies. For patients discharged and readmitted to the ICU within 28 days of study enrolment still requiring EN, data pertaining to their initial admission only will be included.
The following information will be collected daily (based on a 2
Data will be collected for all eligible patients as part of standard clinical practice. Both protein prescription and delivery will be collected while the patient is receiving enteral nutrition (EN), up to 28 days, until the patient is discharged from ICU, or dies. For patients discharged and readmitted to the ICU within 28 days of study enrolment still requiring EN, data pertaining to their initial admission only will be included. The following information will be collected daily (based on a 24 hour calendar day): 1. Nutrition intake: · Enteral nutrition prescription: At 08:00 each day, the formula name and daily volume prescribed. · Total enteral nutrition delivered: Formula name, total volume administered within 24 hour period. · Additional protein delivered. i. Enteral nutrition supplements (e.g. Beneprotein) ii. Parenteral nutrition 2. Feed tolerance: · Total Gastric Residual Volume (GRV) aspirated in 24 hours · Total GRV discarded in 24 hours. Discontinuation of data collection and/or withdrawal: 1. Cessation of EN by the treating clinicians 2. Patient is discharged from the ICU before day 28 3. Oral nutrition is commenced 4. Patient dies prior to day 28
Sponsors
Intensive Care Research, Royal Adelaide Hospital.
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Aged 18 years or older. 2. Receiving invasive mechanical ventilation. 3. About to commence enteral nutrition (EN) or EN commenced within the preceding 12 hours.
Exclusion criteria
1. Expected to be receiving oral nutrition within 24 hours of inclusion. 2. Have received EN or parenteral nutrition (PN) for >12 hours in the ICU admission. 3. Death is deemed to be imminent or inevitable during this admission and either the attending doctor, patient or substitute decision maker is not committed to active treatment 4. The patient has an underlying disease that makes survival to 90 days unlikely 5. The patient has a condition in which the treating clinician believes that administration of a very large or small amount of protein (e.g. large burn injury or urea cycle disorder respectively) is indicated.
Outcome results
None listed