Whole-body protein kinetics in critically ill patients during 50 or 100% energy provision by enteral nutrition: A randomized cross-over study.
Adult
Aged
Carbon Isotopes
/ chemistry
Critical Illness
Cross-Over Studies
Energy Intake
Energy Metabolism
Enteral Nutrition
/ methods
Female
Humans
Intensive Care Units
Isotope Labeling
Kinetics
Male
Middle Aged
Parenteral Nutrition
Phenylalanine
/ chemistry
Proteins
/ metabolism
Whole-Body Counting
/ methods
Journal
PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081
Informations de publication
Date de publication:
2020
2020
Historique:
received:
12
03
2020
accepted:
16
09
2020
entrez:
5
10
2020
pubmed:
6
10
2020
medline:
28
11
2020
Statut:
epublish
Résumé
Enteral nutrition (EN) is a ubiquitous intervention in ICU patients but there is uncertainty regarding the optimal dose, timing and importance for patient-centered outcomes during critical illness. Our research group has previously found an improved protein balance during normocaloric versus hypocaloric parenteral nutrition in neurosurgical ICU patients. We now wanted to investigate if this could be demonstrated in a general ICU population with established enteral feeding, including patients on renal replacement therapy. Patients with EN >80% of energy target as determined by indirect calorimetry were randomized to or 50% or 100% of current EN rate. After 24 hours, whole-body protein kinetics were determined by enteral and parenteral stable isotope tracer infusions. Treatment allocation was then switched, and tracer investigations repeated 24 hours later in a crossover design with patients serving as their own controls. Six patients completed the full protocol. During feeding with 100% EN all patients received >1.2 g/kg/day of protein. Mean whole-body protein balance increased from -6.07 to 2.93 µmol phenylalanine/kg/h during 100% EN as compared to 50% (p = 0.044). The oxidation rate of phenylalanine was unaltered (p = 0.78). It is possible to assess whole-body protein turnover using a stable isotope technique in critically ill patients during enteral feeding and renal replacement therapy. Our results also suggest a better whole-body protein balance during full dose as compared to half dose EN. As the sample size was smaller than anticipated, this finding should be confirmed in larger studies.
Sections du résumé
BACKGROUND
Enteral nutrition (EN) is a ubiquitous intervention in ICU patients but there is uncertainty regarding the optimal dose, timing and importance for patient-centered outcomes during critical illness. Our research group has previously found an improved protein balance during normocaloric versus hypocaloric parenteral nutrition in neurosurgical ICU patients. We now wanted to investigate if this could be demonstrated in a general ICU population with established enteral feeding, including patients on renal replacement therapy.
METHODS
Patients with EN >80% of energy target as determined by indirect calorimetry were randomized to or 50% or 100% of current EN rate. After 24 hours, whole-body protein kinetics were determined by enteral and parenteral stable isotope tracer infusions. Treatment allocation was then switched, and tracer investigations repeated 24 hours later in a crossover design with patients serving as their own controls.
RESULTS
Six patients completed the full protocol. During feeding with 100% EN all patients received >1.2 g/kg/day of protein. Mean whole-body protein balance increased from -6.07 to 2.93 µmol phenylalanine/kg/h during 100% EN as compared to 50% (p = 0.044). The oxidation rate of phenylalanine was unaltered (p = 0.78).
CONCLUSIONS
It is possible to assess whole-body protein turnover using a stable isotope technique in critically ill patients during enteral feeding and renal replacement therapy. Our results also suggest a better whole-body protein balance during full dose as compared to half dose EN. As the sample size was smaller than anticipated, this finding should be confirmed in larger studies.
Identifiants
pubmed: 33017434
doi: 10.1371/journal.pone.0240045
pii: PONE-D-20-06211
pmc: PMC7535026
doi:
Substances chimiques
Carbon Isotopes
0
Proteins
0
Phenylalanine
47E5O17Y3R
Carbon-13
FDJ0A8596D
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
e0240045Déclaration de conflit d'intérêts
We have read the journal's policy and the authors of this manuscript have the following competing interests: JW and OR have given paid lectures about nutrition in the ICU for Nestlé, Nutricia and Fresenius Kabi. OR is a consultant for Fresenius-Kabi. FL has received a speaking fee from Baxter. MSR has no competing interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.
Références
Clin Nutr. 2019 Feb;38(1):48-79
pubmed: 30348463
Intensive Care Med. 2017 Nov;43(11):1637-1647
pubmed: 28936712
Clin Nutr. 2015 Feb;34(1):95-100
pubmed: 24556361
JPEN J Parenter Enteral Nutr. 2018 Nov;42(8):1252-1262
pubmed: 29701878
Ann Surg. 1987 Mar;205(3):288-94
pubmed: 3103555
N Engl J Med. 2018 Nov 08;379(19):1823-1834
pubmed: 30346225
JPEN J Parenter Enteral Nutr. 2016 Aug;40(6):795-805
pubmed: 26635305
Curr Opin Clin Nutr Metab Care. 2018 Nov;21(6):417-422
pubmed: 30148741
Am J Physiol. 1989 May;256(5 Pt 1):E631-9
pubmed: 2719103
Am J Clin Nutr. 2015 Mar;101(3):549-57
pubmed: 25733640
N Engl J Med. 2011 Aug 11;365(6):506-17
pubmed: 21714640
Crit Care Med. 2010 Feb;38(2):395-401
pubmed: 19851094
Crit Care. 2018 Jan 23;22(1):12
pubmed: 29361959
Crit Care. 2012 Dec 07;16(6):249
pubmed: 23216871
Crit Care. 2016 Nov 4;20(1):358
pubmed: 27814776
Crit Care. 2015 Mar 12;19:106
pubmed: 25882298
JPEN J Parenter Enteral Nutr. 2016 Feb;40(2):159-211
pubmed: 26773077
Clin Nutr. 2014 Oct;33(5):802-7
pubmed: 24269078
Crit Care. 2017 Dec 06;21(1):298
pubmed: 29212550
Ann Surg. 1983 Feb;197(2):163-71
pubmed: 6824370
JPEN J Parenter Enteral Nutr. 2018 Sep;42(7):1112-1122
pubmed: 29603281
Crit Care. 2017 Jun 9;21(1):142
pubmed: 28599676
Br J Surg. 1990 Apr;77(4):413-6
pubmed: 2111195
Crit Care. 2013 Jul 24;17(4):R158
pubmed: 23883571
N Engl J Med. 2015 Jun 18;372(25):2398-408
pubmed: 25992505
Curr Opin Clin Nutr Metab Care. 2019 Mar;22(2):146-151
pubmed: 30585804