Hopkins B, Cohen SS, Irvin SR, Alberda C. 2019. Achieving protein targets in the ICU using a specialized high-protein enteral formula: A quality improvement project. Nutr Clin Practice, DOI: 10.1002/ncp.10364 – Hopkins_Cohen_NCP_2019.
Background: To meet protein needs in critical illness (CI), guidelines suggest 1.2–2.5 g protein/kg/d; however, most intensive care unit (ICU) patients receive 0.7 g/kg/d. Higher protein enteral nutrition (EN) formulas may be part of the solution to provide prescribed protein. Our objective was to demonstrate that an EN formula with 37% protein can deliver 80% of prescribed protein, without overfeeding calories within the first 5 days of feeding and to describe ICU clinicians’ experience. Methods: This quality improvement (QI) project included patients requiring exclusive EN for up to 5 days from 6 Canadian ICUs. Rationale for choosing formula included patient’s BMI (kg/m2), nutrition targets, daily protein and energy delivered feeding interruptions, and general tolerance. Results: Forty-four of 49 patients received the formula 2 days. Average protein prescribed was 137.5 g/d (82.5–200) or 1.9 g/kg/d (1.5–2.5). Average protein delivered was 116.9 g/d (33.5–180) or 1.6 g/kg/d (0.4–2.4). Seventy-five percent to 83% of patients received 80% prescribed protein on days 2–5. Average energy prescribed was 1638.6 kcal/d (990–2500) or 17.8 kcal/kg (11–26). Average energy delivered was 1523.9 kcal/d (693.0–2557.5) or 17.3 kcal/kg/d (1.35–64.7). The formula was well tolerated with no gastrointestinal symptoms reported in 38 (86%) patients. The most common reasons to prescribe the formula were obesity and use of fat-based medications. Conclusions: We demonstrated in a QI study that a high-protein EN formula was tolerated in a small, heterogeneous group of ICU patients and effective in meeting protein targets without overfeeding. (Nutr Clin Pract. 2019;0:1–10)