Optimizing Protein Intake and Nitrogen Balance in Adult Critically Ill Patients (OPINiB)
Protein Deficiency
About this trial
This is an interventional prevention trial for Protein Deficiency focused on measuring PROTEIN SUPPLEMENTATION, NUTRITIONAL STATUS
Eligibility Criteria
Inclusion criteria:
- Age > 18 years
- Receiving PN and/or EN nutrition
- Indwelling urinary catheter
- Mechanically ventilated patients
Exclusion criteria:
- Age < 18 years
- Chronic renal or hepatic failure
- Current or history (past 6 months) of GI bleeding
- BMI >30 kg/m2 o <18 kg/m2
- Terminally ill patients
- Pregnancy
Sites / Locations
Arms of the Study
Arm 1
Arm 2
Experimental
No Intervention
PROTEIN-FORTIFIED DIET
STANDARD DIET
The protein-fortified diet consists on an energy goal based on REE measurement and a protein target based on the most recent literature recommendations (1.2-2 g/kg/die) (2). Daily caloric requirement, and subsequent protein content, of patients enrolled in the intervention group will be calculated using formulas in Table 1 (10, 12, 13). For each patient will be calculated the Resting Energy Expenditure (REE) and daily protein requirement (1.2-2g/kg/die of body weight registered at the admission) and the corresponding caloric intake (1g = 4 kcal). Finally, total daily caloric intake will be calculated by adding kcal from protein (1g = 4kcal) on kcal from non-protein (50% of REE).
The standard diet consists on an energy goal based on weight formula (20-25 kcal/kg/die). According to the ICU nutritional protocol, EN is started at an initial rate of 10ml/h, and increased by 20ml/h every 12 hours in the absence of significant gastric residuals (<250ml), with the aim of reaching the energy goal within 72 hours from admission. The EN formulae used are standard (1-1,5 kcal/ml, 40g/l protein). If enteral nutrition is not tolerated or is not indicated, supplemental PN is used to make up the energy shortfall. The PN formula used is standard (1000 kcal/l, 37 g/l protein).