ESICM LIVES 2021: Part 1
Intensive Care Medicine Experimental
Introduction. The optimal integration between adequate protein intake and exercise in critically ill patients may have an impact on short and long-term outcomes, but this hypothesis has not been tested in studies with good methodology. In the given context, we conducted a prospective randomized controlled trial to evaluate the efficacy of high protein intake and early exercise versus guidelines recommended protein intake and routine physiotherapy on outcome of critically ill patients. Methods.
... e randomized mechanically ventilated patients expected to stay in the intensive care unit (ICU) for at least 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 2.0 g/ kg/day and 1.4 g/kg/day 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 the 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 hospital mortality was expressively higher in the control group (p = 0.006). 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 resistive exercise increase the survival rate and the physical quality of life of critically ill patients.