Journal Article

High-protein intake and early exercise in adult intensive care patients: a prospective, randomized controlled trial to evaluate the impact on functional outcomes

Lima, Hugo César Martins, de Azevedo, José Raimundo Araujo, Nogueira, Ivna Raquel Olimpio Moreira, Fernandes, Erika Arana Arraes, Frota, Pedro Henrique Dias Brasiliense, de Souza, Suellen Christine, Cruz, Adlyene Muniz

2021

Overview

Background We evaluated the efficacy of high protein intake and early exercise versus standard nutrition care and routine physiotherapy on the outcome of critically ill patients. Methods We randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for 4 days. We used indirect calorimetry to determine energy expenditure and guide caloric provision to the patients randomized to the high protein and early exercise (HPE) group and the control group. Protein intakes were 1.48 g/kg/day and 1.19 g/kg/day medians respectively; while the former was submitted to two daily sessions of cycle ergometry exercise, the latter received routine physiotherapy. We evaluated the primary outcome physical component summary (PCS) score at 3 and 6 months) and the secondary outcomes (handgrip strength at ICU discharge and ICU and hospital mortality). Results We analyzed 181 patients in the HPE (87) and control (94) group. There was no significant difference between groups in relation to calories received. However, the amount of protein received by the HPE group was significantly higher than that received by the control group ( p  < 0.0001). The PCS score was significantly higher in the HPE group at 3 months ( p  = 0.01) and 6 months (p = 0.01). The mortality was expressively higher in the control group. We found an independent association between age and 3-month PCS and that between age and group and 6-month PCS. Conclusion This study showed that a high-protein intake and resistance exercise improved the physical quality of life and survival of critically ill patients. Trial registration Research Ethics Committee of Hospital São Domingos: Approval number 1.487.683, April 09, 2018. The study protocol was registered in ClinicalTrials.gov ( NCT03469882 , March 19,2018).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age Factors / Aged / Aged, 80 and over / Amino acids / Analysis / Anesthesiology / Calories / Calorimetry / Clinical trials / Consent / Critical care / Critical Care Medicine / Critical Illness - mortality / Diet, High-Protein / Drug dosages / Emergency Medicine / Energy expenditure / Ergometry / Exercise / Exercise Therapy - methods / Female / Hand Strength - physiology / Hospital Mortality / Hospitals / Humans / Illnesses / Indirect calorimetry / Intensive / Intensive care / Intensive Care Units / Internal Medicine / Length of stay / Male / Medicine / Medicine & Public Health / Middle Aged / Mortality / Neuromuscular diseases / Nutrition research / Outcome / Parenteral nutrition / Patients / Physical component summary / Physical fitness / Physical therapy / Physical Therapy Modalities / Prospective Studies / Protein / Proteins / Quality of Life / Research Article / Resistance training / Respiration, Artificial / Therapeutics, Physiological / Time Factors / Trauma / United Kingdom / Ventilators