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Personalized nutritional interventions are essential for critically ill patients in the ICU, as higher enteral protein provision may impair recovery and diminish quality of life.
A recent study published in ‘The Lancet’ challenged the effectiveness of high-protein nutrition for critically ill patients. The PRECISe trial (conducted in Belgium and the Netherlands) examined the impact of increased enteral protein provision on health-related well-being and recovery of physical capabilities in patients on ventilator support.
Overall, 935 patients requiring invasive mechanical ventilation within 24 hours of intensive care unit (ICU) admission were included, with exclusions for specific health conditions and contraindications for enteral nutrition. The included patients were randomly allocated to receive either standard (1.3 g per kg given daily) or high (2.0 g per kg given daily) enteral protein.
Despite anticipated that the greater protein intake would ease muscle wasting and enhance recovery, the results were surprising. The high-protein group had lower EuroQoL 5-Dimension 5-level (EQ-5D-5L) health utility scores at 30, 90, and 180 days post-ICU admission, with a mean difference of –0.05 compared to the standard-protein group. This suggests that higher protein provision may not improve long-term outcomes, and could even contribute to worse health-related quality of life.
While the safety outcomes did not show a significant difference in mortality rates, there was a higher incidence of gastrointestinal intolerance in patients receiving the high-protein diet. Other adverse events did not vary amongst the trial groups. The findings of this trial highlight the complexity of nutritional strategies in critical care and suggest that more protein may not always equate to better recovery.
The Lancet
Effect of high versus standard protein provision on functional recovery in people with critical illness (PRECISe): an investigator-initiated, double-blinded, multicentre, parallel-group, randomised controlled trial in Belgium and the Netherlands
Julia L M Bels et al.
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