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Cited by 245Clinical Nutrition and GastroenterologyMuscle metabolism and nutritionSepsis Diagnosis and Treatment

Optimal protein requirements during the first 2 weeks after the onset of critical illness

Ishibashi, Nobuya, Plank, Lindsay D., Sando, Kinya, Hill, Graham L.·1998·Critical Care Medicine
DOI 10.1097/00003246-199809000-00020
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Abstract

OBJECTIVE: To obtain optimal protein requirements in critically ill sepsis or trauma patients during the first 2 wks after admission to the intensive care unit. DESIGN: Retrospective study. SETTING: Department of critical care medicine at a teaching hospital. PATIENTS: Immediate posttrauma patients or severely septic patients. INTERVENTIONS: In vivo neutron activation analysis was used to measure changes in total body protein over a 10-day period which began as soon as the patients were hemodynamically stable. The patients (trauma, n=18; sepsis, n=5) were divided into three groups according to the average daily protein intakes. Because the patients were overhydrated (approximately 10 L) and had variable amounts of body fat, the protein intakes were indexed to normally hydrated (corrected) fat-free mass (FFMc): Groups A, B, and C received an average of 1.1, 1.5, and 1.9 g/kg FFMc/day protein, respectively. MEASUREMENTS AND MAIN RESULTS: Overall, the average loss of total body protein was 1.2=0.7 (SD) kg. Changes in total body protein were significantly (p=.011) different between the three groups. The loss of body protein was significantly more in group A compared with groups B (p=.013) and C (p=.023). When the protein intake was increased from 1.1 g/kg FFMc/day to 1.5 g/kg FFMc/day, protein loss was halved. Further increase in protein intake up to 1.9 g/kg FFMc/day resulted in no further improvement. An intake of 1.5 g/kg FFMc/day was equivalent to 1.0 g/day/kg of body weight measured at the beginning of the study. CONCLUSIONS: Current recommended protein requirements of 1.2 to 2.0 g/kg of body weight/day are excessive if they are indexed to the body weight measured soon after the onset of critical illness. Because individual patients have varying degrees of overhydration early in the illness onset, we suggest that the intensivist should obtain information on preillness body weight and prescribe 1.2g of protein/kg body weight/day. If information is not available, 1.0g of protein/day/kg of measured body weight will give a fair approximation to optimal protein requirements.

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Authors
Ishibashi, N., Plank, L. D., Sando, K., & Hill, G. L.
Affiliations
University of Auckland (NZ)
ORCID
Plank, Lindsay D.
Venue
Critical Care Medicine
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
1998-09
Volume
26
Issue
9
Pages
1529-1535
ISSN
0090-3493 (ISSN-L)
DOI
10.1097/00003246-199809000-00020
OpenAlex
W2014358333
Cited by
245
References
18
Citations by year
2026: 3 · 2025: 4 · 2024: 6 · 2023: 3 · 2022: 2 · 2021: 8 · 2020: 8 · 2019: 8 · 2018: 18 · 2017: 11 · 2016: 11 · 2015: 13 · 2014: 22 · 2013: 18 · 2012: 8
FWCI
4.94
Type
journal article
Language
en
Open access
closed
Locations
  • Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Cell Biology › Muscle metabolism and nutrition
  • Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
Keywords
protein requirements, critical illness, sepsis, trauma (physical injury), fat-free mass, protein intake, fluid overload, intensive care unit
MeSH terms
Adolescent, Adult, Aged, Critical Care, Dietary Proteins, Female, Humans, Male, Middle Aged, Nutritional Requirements, Retrospective Studies, Time Factors, Wounds and Injuries, Bacteremia, Critical Illness

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