Replacing Protein Via Enteral Nutrition in a Stepwise Approach in Critically Ill Patients

Patients will be recruited on day 1-2 of ICU admission. On day 5, patients will be randomized into one of the two intervention arms;

Replenish Protein group:

Patients randomized to this group will receive 2 g of protein/kg/day (acceptable range 1.8 - 2.2 g of protein/kg/day) for day 6-14.

Standard Protein group:

Patients randomized to this group will receive protein at 0.8 - 1.0 g of protein/kg/day for day 6-14

Inclusion criteria

• Age ≥ 18 years
• Mechanically ventilated
• Receiving enteral feeding via nasogastric/orogastric or duodenal or PEG or jejunostomy tubes and
• Expected to stay ≥ 1 week in the ICU

Exclusion criteria

• Lack of commitment to ongoing life support, which includes;

• Terminal Illness (Malignancy or irreversible condition with 6 month mortality > 50%)
• DNR order in the first 48 hours and brain death within 48 hours of admission) (Don't include the presence of a "Do Not Resuscitate" order alone, if there is a commitment to ongoing life support).
• Patients not fed within 48 hours of admission
• Patients on total parenteral nutrition (TPN)
• Patients being fed orally
• Chronic renal failure
• Chronic liver disease
• Renal replacement therapy
• Pregnancy.
• Kidney transplant
• Post-liver transplant.
• Post cardiac arrest.
• Burn patients.
• Prisoners

Screened patients will be screened again for eligibility at day 5, should be mechanically ventilated and expected to stay ≥ 3 days in the ICU. At this point, patients will be excluded if they meet the following;

• New onset renal replacement therapy.
• Acute Kidney Injury (serum creatinine > 3 times the preacute level or serum creatinine >350mmol/L with a recent increase of >44 mmols/L)
• Significant liver impairment