title: Experimental and Outcome-Based Approaches to Protein Requirements in the Intensive Care Unit.
abstract: Insight into protein requirements of intensive care unit (ICU) patients is urgently needed, but at present, it is unrealistic to define protein requirements for different diagnostic groups of critical illness or at different stages of illness. No large randomized controlled trials have randomized protein delivery, adequately addressed energy intake, and evaluated relevant clinical outcomes. As a pragmatic approach, experimental studies have focused on protein requirements of heterogeneous ICU patients. Data are scarce and the absolute value of protein requirements therefore is an approximation. Experimental studies indicate a protein requirement of >1.2 g/kg protein, which is supported by several outcome-based observational studies. Protein intake levels of up to 2.0-2.5 g/kg appear to be safe. A higher level of personalized treatment, within 1.2 and 2.5 g/kg, must involve identification of patients with low muscle protein mass that might benefit most from adequate protein nutrition in the ICU.
authors.affiliation: 1 Nutrition and Dietetics, Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands.|2 Nutrition and Dietetics, Faculty of Sports and Nutrition, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands.|3 Department of Intensive Care Medicine, VU University Medical Center, Amsterdam, the Netherlands.|4 Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands.
authors.forename: Peter J M
authors.initials: PJ
authors.lastname: Weijs
authors.affiliation: 5 Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Memphis, Tennessee, USA.
authors.forename: Roland N
authors.initials: RN
authors.lastname: Dickerson
authors.affiliation: 6 Clinical Evaluation Research Unit, Kingston General Hospital, Kingston, Ontario, Canada.|7 Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada.
authors.forename: Daren K
authors.initials: DK
authors.lastname: Heyland
authors.affiliation: 8 Department of Surgery, Division of Acute Care Surgery, and Center for Sepsis and Critical Illness Research, University of Florida College of Medicine, Gainesville, Florida, USA.
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Moore
authors.affiliation: 9 Department of Surgery, Pontificia Universidad Javeriana, Medical School, Hospital Universitario San Ignacio, Bogotá, Colombia.
authors.forename: Saúl J
authors.initials: SJ
authors.lastname: Rugeles
authors.affiliation: 10 Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Stephen A
authors.initials: SA
authors.lastname: McClave
mesh_terms: D016638:Critical Illness; D004044:Dietary Proteins; D002149:Energy Intake; D004750:Enteral Nutrition; D006801:Humans; D007362:Intensive Care Units; D009751:Nutritional Requirements; D010288:Parenteral Nutrition
chemical_list: D004044:Dietary Proteins
keywords: critical illness; energy; intensive care unit; nitrogen; protein