Appropriate protein provision in critical illness: a systematic and narrative review.
BACKGROUND
Widely varying recommendations have been published with regard to the appropriate amount of protein or amino acids to provide in critical illness.


OBJECTIVE
We carried out a systematic review of clinical trials that compared the metabolic or clinical effects of different protein intakes in adult critical illness and comprehensively reviewed all of the available evidence pertinent to the safe upper limit of protein provision in this setting.


METHODS
MEDLINE was searched for clinical trials published in English between 1948 and 2012 that provided original data comparing the effects of different levels of protein intake on clinically relevant outcomes and evidence pertinent to the safe upper limit of protein provision to critically ill adults.


RESULTS
The limited amount and poor quality of the evidence preclude conclusions or clinical recommendations but strongly suggest that 2.0-2.5 g protein substrate · kg normal body weight⁻¹ · d⁻¹ is safe and could be optimum for most critically ill patients. At the present time, most critically ill adults receive less than half of the most common current recommendation, 1.5 g protein · kg⁻¹ · d⁻¹, for the first week or longer of their stay in an intensive care unit.


CONCLUSIONS
There is an urgent need for well-designed clinical trials to identify the appropriate level of protein provision in critical illness.
Lady Davis Institute for Medical Research, Jewish General Hospital, McGill University, Montreal, Canada. l.hoffer@mcgill.ca
L John
LJ
Hoffer
Bruce R
BR
Bistrian
D000328:Adult; D000596:Amino Acids / Q000008:administration & dosage / Q000009:adverse effects / Q000378:metabolism; D003422:Critical Care; D018753:Diet, Protein-Restricted / Q000009:adverse effects; D004044:Dietary Proteins / Q000008:administration & dosage* / Q000009:adverse effects / Q000378:metabolism; D019317:Evidence-Based Medicine; D006801:Humans; D007362:Intensive Care Units
D000596:Amino Acids; D004044:Dietary Proteins