[Effect of increasing protein ingestion on the nitrogen balance of mechanically ventilated critically ill patients receiving total parenteral nutrition].
The amount of protein recommended to minimise N loss in critically ill patients receiving total parenteral nutrition (TPN) varies in the literature. Therefore, we studied the effect of increased protein intake on the N balance, administering TPN with either 1.2 g protein/kg/day (low N diet) or 1.8 g protein/kg/day (high N diet). Fifteen mechanically ventilated critically ill patients were studied in a surgical intensive care unit. After at least two days of standard TPN, patients were randomly assigned to either the low or the high N diet. Ten patients were studied on the low N diet and 11 on the high N diet; 6 patients were studied on both diets. Nonprotein energy was supplied according to estimated energy requirements. For five consecutive days, the N balance was measured daily. Total urinary nitrogen (TUN) was analysed using the Kjeldahl method. There was no difference in N balance between the groups. On the low N diet, N balance was -0.113 +/- 0.088 and on the high N diet -0.113 +/- 0.109 g N/kg/day. In patients studied twice, N balance was -0.087 +/- 0.054 and -0.050 +/- 0.060 g N/kd/day respectively. Results of a previous pilot study showed that in 20 similar patients the N balance became 80% less negative (from -5.7 +/- 5.1 to -1.1 +/- 8.2 g N/day) when protein intake was increased from 0.9 to 1.5 g/kg/day. Since these results are consistent with other studies, we conclude that the optimal range of protein supply in this type of critically ill patients is approximately 1.1-1.5 g protein/kg/day.
van der Heijden
A
A
Departamento de Fisiología Humana y Animal, Universidad Agrícola, Wageningen.
Verbeek
M J
MJ
Schreurs
V V
VV
Akkermans
L M
LM
Vos
A
A
D000293:Adolescent; D000328:Adult; D003422:Critical Care; D004044:Dietary Proteins / Q000008:administration & dosage*; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009584:Nitrogen / Q000378:metabolism*; D009751:Nutritional Requirements; D010289:Parenteral Nutrition, Total; D011446:Prospective Studies; D011897:Random Allocation; D012121:Respiration, Artificial
D004044:Dietary Proteins; D009584:Nitrogen
Efecto del aumento de la ingesta de proteínas sobre el balance nitrogenado en pacientes críticos ventilados mecánicamente y sometidos a nutrición parenteral total.