Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Optimal energy and protein delivery goals for critically ill patients remain unknown. The purpose of this systematic review and meta-analysis was to compare the impact of energy and protein delivery during the first 4 to 10 days of an ICU stay on physical impairments. We performed a systematic liter...
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| Format: | Article |
| Language: | English |
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MDPI AG
2022-11-01
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| Series: | Nutrients |
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| Online Access: | https://www.mdpi.com/2072-6643/14/22/4849 |
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| author | Nobuto Nakanishi Shinya Matsushima Junko Tatsuno Keibun Liu Takahiko Tamura Hiroshi Yonekura Norimasa Yamamoto Takeshi Unoki Yutaka Kondo Kensuke Nakamura |
| author_facet | Nobuto Nakanishi Shinya Matsushima Junko Tatsuno Keibun Liu Takahiko Tamura Hiroshi Yonekura Norimasa Yamamoto Takeshi Unoki Yutaka Kondo Kensuke Nakamura |
| author_sort | Nobuto Nakanishi |
| collection | DOAJ |
| description | Optimal energy and protein delivery goals for critically ill patients remain unknown. The purpose of this systematic review and meta-analysis was to compare the impact of energy and protein delivery during the first 4 to 10 days of an ICU stay on physical impairments. We performed a systematic literature search of MEDLINE, CENTRAL, and ICHUSHI to identify randomized controlled trials (RCTs) that compared energy delivery at a cut-off of 20 kcal/kg/day or 70% of estimated energy expenditure or protein delivery at 1 g/kg/day achieved within 4 to 10 days after admission to the ICU. The primary outcome was activities of daily living (ADL). Secondary outcomes were physical functions, changes in muscle mass, quality of life, mortality, length of hospital stay, and adverse events. Fifteen RCTs on energy delivery and 14 on protein were included in the analysis. No significant differences were observed in any of the outcomes included for energy delivery. However, regarding protein delivery, there was a slight improvement in ADL (odds ratio 21.55, 95% confidence interval (CI) −1.30 to 44.40, <i>p</i> = 0.06) and significantly attenuated muscle loss (mean difference 0.47, 95% CI 0.24 to 0.71, <i>p</i> < 0.0001). Limited numbers of RCTs were available to analyze the effects of physical impairments. In contrast to energy delivery, protein delivery ≥1 g/kg/day achieved within 4 to 10 days after admission to the ICU significantly attenuated muscle loss and slightly improved ADL in critically ill patients. Further RCTs are needed to investigate their effects on physical impairments. |
| first_indexed | 2024-03-09T18:05:04Z |
| format | Article |
| id | doaj.art-2e2a1676036c4217914104e7c117a87f |
| institution | Directory Open Access Journal |
| issn | 2072-6643 |
| language | English |
| last_indexed | 2024-03-09T18:05:04Z |
| publishDate | 2022-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Nutrients |
| spelling | doaj.art-2e2a1676036c4217914104e7c117a87f2023-11-24T09:32:11ZengMDPI AGNutrients2072-66432022-11-011422484910.3390/nu14224849Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsNobuto Nakanishi0Shinya Matsushima1Junko Tatsuno2Keibun Liu3Takahiko Tamura4Hiroshi Yonekura5Norimasa Yamamoto6Takeshi Unoki7Yutaka Kondo8Kensuke Nakamura9Division of Disaster and Emergency Medicine, Department of Surgery Related, Kobe University Graduate School of Medicine, Kobe 650-0017, JapanDepartment of Rehabilitation Center, St. Marianna University School of Medicine Hospital, Kawasaki 216-8511, JapanDepartment of Quality Management, Kokura Memorial Hospital, Kitakyusyu 802-8555, JapanCritical Care Research Group, The Prince Charles Hospital, Brisbane, QLD 4032, AustraliaDepartment of Anesthesiology and Intensive Care Medicine, Kochi Medical School, Nankoku City 783-8505, JapanDepartment of Anesthesiology and Pain Medicine, Fujita Health University Bantane Hospital, Nagoya City 454-8509, JapanDepartment of Acute and Critical Care Nursing, Toyama Chuo Hospital, Toyama City 930-8550, JapanDepartment of Acute and Critical Care Nursing, School of Nursing, Sapporo City University, Sapporo 005-0864, JapanDepartment of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Urayasu 279-0021, JapanDepartment of Emergency Medicine, Teikyo University Hospital, Tokyo 173-8606, JapanOptimal energy and protein delivery goals for critically ill patients remain unknown. The purpose of this systematic review and meta-analysis was to compare the impact of energy and protein delivery during the first 4 to 10 days of an ICU stay on physical impairments. We performed a systematic literature search of MEDLINE, CENTRAL, and ICHUSHI to identify randomized controlled trials (RCTs) that compared energy delivery at a cut-off of 20 kcal/kg/day or 70% of estimated energy expenditure or protein delivery at 1 g/kg/day achieved within 4 to 10 days after admission to the ICU. The primary outcome was activities of daily living (ADL). Secondary outcomes were physical functions, changes in muscle mass, quality of life, mortality, length of hospital stay, and adverse events. Fifteen RCTs on energy delivery and 14 on protein were included in the analysis. No significant differences were observed in any of the outcomes included for energy delivery. However, regarding protein delivery, there was a slight improvement in ADL (odds ratio 21.55, 95% confidence interval (CI) −1.30 to 44.40, <i>p</i> = 0.06) and significantly attenuated muscle loss (mean difference 0.47, 95% CI 0.24 to 0.71, <i>p</i> < 0.0001). Limited numbers of RCTs were available to analyze the effects of physical impairments. In contrast to energy delivery, protein delivery ≥1 g/kg/day achieved within 4 to 10 days after admission to the ICU significantly attenuated muscle loss and slightly improved ADL in critically ill patients. Further RCTs are needed to investigate their effects on physical impairments.https://www.mdpi.com/2072-6643/14/22/4849critically ill patientnutrition therapyenergyproteinphysical impairment |
| spellingShingle | Nobuto Nakanishi Shinya Matsushima Junko Tatsuno Keibun Liu Takahiko Tamura Hiroshi Yonekura Norimasa Yamamoto Takeshi Unoki Yutaka Kondo Kensuke Nakamura Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials Nutrients critically ill patient nutrition therapy energy protein physical impairment |
| title | Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full | Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_fullStr | Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_full_unstemmed | Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_short | Impact of Energy and Protein Delivery to Critically Ill Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials |
| title_sort | impact of energy and protein delivery to critically ill patients a systematic review and meta analysis of randomized controlled trials |
| topic | critically ill patient nutrition therapy energy protein physical impairment |
| url | https://www.mdpi.com/2072-6643/14/22/4849 |
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