Protein requirements, morbidity and mortality in critically ill patients: fundamentals and applications

Haroldo Falcão Ramos da Cunha, Eduardo Eiras Moreira da Rocha, Monica Hissa, Haroldo Falcão Ramos da Cunha, Eduardo Eiras Moreira da Rocha, Monica Hissa

Abstract

Recent evidence suggests that a negative protein balance secondary to severe disease is associated with increased morbidity. A loss of total body protein is inevitable in this scenario, even with an aggressive nutritional approach, primarily due to the catabolism of skeletal muscle fibers. The ubiquitin-proteasome system is the primary metabolic and biochemical mechanism involved in this process; paradoxically, this system consumes adenosine triphosphate as its energy source. It is possible that a neutral protein balance in these clinical situations is important for improving outcomes and achieving the caloric goals estimated or measured by indirect calorimetry. Recent studies have suggested that the use of higher protein concentrations in nutritional therapy for critically ill patients may help to reduce mortality. The purpose of this study was to review some of the nutrition therapy principles related to protein metabolism, evaluate the main assertions of the guidelines of specialty societies and review the recent studies that address these issues using critical insights from the authors' clinical experience.

Conflict of interest statement

Conflicts of interest: None.

Figures

Figure 1
Figure 1
Urinary excretion of nitrogen in subjects receiving intravenous infusion of glucose in different clinical contexts. Adapted from Elwyn DH. Protein metabolism and requirements in the critically ill patient. Crit Care Clin. 1987;3(1):57-69. *Fasting alone, without concomitant disease. THA - total hip arthroplasty.

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