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ADVANCED MEDICAL NUTRITION

Protein in critical illness

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Loss of muscle mass and associated complications

Loss of muscle mass and malnutrition is common among critically ill patients 1, 2 - 50% will not meet their nutritional targets while in the ICU 3. Nutritional Intervention can have a major impact on survival and recovery for these patients. Intensive care malnutrition is the result of increased catabolism and patients’ nutritional needs. Malnourished patients have several complications, such as prolonged respiratory dysfunction and increased mortality 4, 5. Protein is the most Important macronutrient in this phase, contributing to the conservation of lean body mass and has also been shown to impact both mortality and mobility 4, 5. Adequate supply of protein is thus fundamental in the treatment of critically ill patients and an early start of protein-rich enteral nutritional therapy is important as it has been shown to reduce length of stay, occurrence of infectious complications and spontaneous wounds 6.

Early administration of high protein enteral nutrition is important


To prevent muscle loss, protein-rich enteral nutrition should be given to all critically ill patients who are not expected to resume normal diet within 3 days 7.


Protein-rich enteral nutrition should start within the first 24-48 hours after admission 8, 9.


Increased protein supply is associated with increased survival 10, 11.

Timing and type of protein is important

The amount, type and timing of protein delivery affects the patient's outcome in critical illness 12. Protein helps maintain muscle mass, improve wound healing and promotes patient recovery 13, it is essential that the patient tolerates the enteral solution well so that protein and energy targets are reached early. Enteral feeding products should provide a well-tolerated solution with a protein supply that fully meets International guidelines without risking over feeding calories.

If you would like to know more, watch the two videos of Nutricia Congresses below:

Congress ESPEN 2018 Madrid, Spain

  • Critical care and surgery
  • Physical frailty and disease related malnutrition

Watch the video on www.nutriciacongresses.com:

The importance of timing and dosing in protein delivery on the ward

 

Congress ESPEN 2018 Madrid, Spain

  • Critical care and surgery

Watch the video on www.nutriciacongresses.com:

Optimising the protein balance in the critically ill patient

Introducing 
Nutrison Protein Intense

The first and only whole protein tube feed with a high protein level that fully meets international critial care guidelines 13-17.

Learn more about our unique solution here

What is Nutrison Protein Intense?

Whole protein

Formulated to meet the latest international nutritional guidelines for critically ill patients with elevated protein needs 14-17.

Read more about the international guidelines here

Unique p4 protein blend

Contains the unique P4 protein blend which is aligned with the latest international nutritional guidelines on protein quality 18, amino acid requirements 19 and has proven supportive tolerance benefits 20-25.

Read more about our p4 protein blend here

 

Scientifically Proven

Scientifically proven to meet protein targets in ICU without over feeding calories 26.

Read more about the results of the studies here

Nutrison Protein Intense

A unique & scientifically proven solution;

  • With whole protein that follows international guidelines
  • P4 for better tolerance and protein quality
  • Achieves protein targets without over-feeding calories

Nutrison Protein Intense is tailored to the diet of critically ill patients and / or patients with high protein needs.

For more product info and product sheets click here

International guidelines recommend starting nutritional treatment with whole protein products

Other solutions may be considered by specific gastrointestinal complications.

SCCM/ASPEN guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient 2016 14
Read the article here

ESPEN guideline on clinical nutrition in the intensive care unit 2006 15
Read the article here

 

 

Canadian Critical Care Nutrition Clinical Practice Guidelines 2013 16
Read the article here

Nutrition therapy for critically ill patients across the Asia-Pacific and Middle East regions 2018 17
Read the article here

The protein mixture p4 is of high quality and well tolerated

  • Proven Tolerance Benefits - P4 is a very well tolerated whole protein blend developed to optimize protein intake 20-25
  • High Quality - A combination of 4 different protein sources with an amino acid pattern that complies with the WHO/FAO/UNU guidelines 19
  • Fully matches Nutritional Guidelines and recommendations - P4 is a whole protein blend used as part of Nutrison Protein Intense to fully match current international nutritional guidelines for critically ill patients 14-17

Nutrison Protein Intense is scientifically proven to meet protein targets without overfeeding calories 26

A very high intact-protein enteral formula is suitable as first-line nutritional treatment for critically ill patients as it offers a solution for adequate protein provision according to nutritional guidelines without overfeeding risk

STUDY OVERVIEW

  • This first trial comparing a very high protein (10 g/100 ml) withstandard high protein enteral formula (6 g/100 ml) based on whole proteins
  • Results: Protein intake according to recommendations is possible with a whole protein tube feed solution

Read the entire study here

References
1. Wischmeyer PE. Are we creating survivors or victims in critical care? Delivering targeted nutrition to improve outcomes. Curr Opin Crit Care. 2016; 22:279-84.
2. Mitchell WK, Williams J, Atherton P, et al. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Frontiers in Physiology. 2012; 3:1-18.
3. Heyland DK, Cahill NE, JA, et al. Impact of Enteral Feeding Protocols on Enteral Nutrition Delivery: Results of a Multicenter Observational Study.Journal of Parenteral and Enteral Nutrition Nutr 2010 34: 675
4. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition. 2016; 40:159-211.
5. Heyland DK, Weijs PJM, Coss-Bu JA, et al. Protein delivery in the intensive care unit: optimal or suboptimal? Nutrition in Clinical Practice. 2017;32:58S-71S.
6. Demling RH. Nutrition, anabolism, and the wound healing process: an overview. ePlasty. 2009; 9:65-94.
7. www.helsebiblioteket.no/fagprosedyrer/ferdige/ernaering-av-voksne-intensivpasienter
8. Kreymann KG, Berger MM, Deutz NEP, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006; 25:210–223.
9. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition. 2016; 40:159-211.
10. Weijs PJM, Looijaard W, Beishuizen A, et al. Early high protein intake is associated with low mortality and energy overfeeding with high mortality in non-septic mechanically ventilated critically ill patients. Critical Care. 2014;18:701-10.
11. Allingstrup, MJ. et al. Provision of protein and energy in relation to measured requirements in intensive care patients.  Clinical Nutrition. 2012; 31: 462-468
12. Koekkoek WAC, van Setten CH, Olthof LE, et al. Timing of protein intake and clinical outcomes of adult critically ill patients on prolonged mechanical ventilation: The PROTINVENT retrospective study. Clinical Nutrition. 2018;xx:1-8 (article in press)
13. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clinical Nutrition. 2018;xxx:1-32 (article in press)
14. McClave SA, Taylor BE, Martindale RG, et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). Journal of Parenteral and Enteral Nutrition. 2016;40:159-211.
15. Kreymann KG, Berger MM, Deutz NEP, et al. ESPEN Guidelines on Enteral Nutrition: Intensive care. Clin Nutr. 2006;25:210–223.
16. Dhaliwal R, Cahill N, Lemieux M, et al. The Canadian Critical Care Nutrition Guidelines in 2013: An Update on Current Recommendations and Implementation Strategies. Nutrition in Clinical Practice. 2014;29:29-43
17. Sioson MS, Martindale R, Abayadeera A, et al. Nutrition therapy for critically ill patients across the Asia-Pacific and Middle East regions: A consensus statement. Clin Nutr ESPEN. 2018;24:156-164. 
18. Hurt RT, McClave SA, Martindale RG, et al. Summary Points and Consensus Recommendations From the International Protein Summit. Nutrition in Clinical Practice. 2017;32:142S–151S
19. World Health Organization. Protein and amino acid requirements in human nutrition:  report of a joint FAO/WHO/UNU expert consultation. 2007; WHO technical report series ; no. 935
20. Kuyumcu S, Menne D, Curcic J, et al. Noncoagulating enteral formula can empty faster from the stomach: A double-blind, randomized crossover trial using magnetic resonance imaging. Journal of Parenteral and Enteral Nutrition. 2015;39:544-551.
21. Van den Braak CC, Klebach M, Abrahamse E, et al. A novel protein mixture containing vegetable proteins renders enteral nutrition products non-coagulating after in vitro gastric digestion. Clinical Nutrition. 2013;32:765-771
22. Klebach M, Hofman Z, Bluemel S, et al. Effect of protein type in enteral nutrition formulas on coagulation in the stomach in vivo: Post hoc analyses of a randomized controlled trial with MRI. Abstract presented at Clinical Nutrition Week,January 16–19; Austin, Tx. Journal of Parenteral and Enteral Nutrition. 2016;40:134(21)
23. Luttikhold J, van Norren K, Rijna H, et al. Jejunal feeding is followed by a greater rise in plasma cholecystokinin, peptide YY, glucagon-like peptide 1, and glucagon-like peptide 2 concentrations compared with gastric feeding in vivo in humans: a randomized trial. Am J Clin Nutr. 2016;103:435–43
24. Abrahamse E, van der Lee S, van den Braak S, et al. Gastric non-coagulation of enteral tube feed yields faster gastric emptying of protein in a dynamic in vitro model. Abstract presented at  34th ESPEN Congress. Sept 8-11; Barcelona, Spain. Clinical Nutrition Supplements. 2012;7:PP239(119)
25. Liu J, Klebach M, Abrahamse E, et al. Specific protein mixture reduces coagulation: An in vitro stomach model study mimicking a gastric condition in critically ill patients. Poster presented at 38th ESPEN Congress. 17-20 September; Copenhagen, Denmark. Clinical Nutrition. 2016;35:MON-P182 (S220)
26. Van Zanten ARH, Petit L, De Waele J, et al. Very high intact-protein formula successfully provides protein intake according to nutritional recommendations in overweight critically ill patients: a double-blind randomized trial. Critical Care. 2018; 22:156-67.