Affiliation:
1. Department of Nutrition Services Alberta Health Services Calgary Alberta Canada
2. Department of Critical Care Medicine University of Calgary Calgary Alberta Canada
3. Division of Gastroenterology, Department of Medicine University of Calgary Calgary Alberta Canada
4. Department of Rehabilitation Alberta Health Services Calgary Alberta Canada
5. Department of Anesthesiology & Surgery Duke University School of Medicine Durham North Carolina USA
6. Department of Nutrition Services Hospital Naval Marcilio Dias Rio de Janeiro Brazil
7. School of Human Nutrition McGill University Montreal Quebec Canada
Abstract
AbstractBackgroundIntensive care unit (ICU) protein benchmarks are based on mortality and morbidity; whether these targets also support functional recovery is unknown. We assessed whether different protein doses influenced patients' functional capacity, measured by the Chelsea Physical Assessment score (CPAx).MethodsSingle‐center retrospective cohort study on ICU survivors with length of stay ≥7 days admitted between October 2014 and September 2020. Eligible patients were divided according to protein intake (g/kg/day): low (<0.8), medium (0.8–1.19), high (1.2–1.5), and very high (>1.5). Protein dose effect on CPAx was assessed at ICU discharge with analysis of covariance adjusting for age, illness severity, hospital length of stay before ICU admission, time to start nutrition support, and mechanical ventilation duration. We also investigated effect modification by energy intake and nutrition status.ResultsEnrolled patients (n = 531) were similar for age, nutrition status, and illness severity across groups. CPAxs were nonlinearly associated with protein doses and similar among low, medium, and very high groups. The CPAx for the high group was statistically different (P = 0.014), indicating that the data of three groups could be pooled. Mean CPAx difference remained statistically significant after adjusting for confounding variables (3.9 ± 1.8, P = 0.029 in the four‐group model, and 2.7 ± 0.9, P = 0.003 in the pooled two‐group model). Energy intake was equivalent between groups and did not modify CPAx. The high group had superior CPAx in both well‐nourished and malnourished patients, indicating nutrition status was not an effect modifier.ConclusionProtein dose 1.2–1.5 g/kg/day was associated with superior functional capacity at ICU discharge compared with other doses. Neither energy intake nor nutrition status modified functional capacity across groups; therefore, the results appear to be influenced by 1.2–1.5 g/kg/day.