PD267 - PROTEINS IN THE CRITICAL PATIENT: DOSES CALCULATED BY TOTAL WEIGHT OR BY BODY COMPOSITION PARAMETERS?

PD267

PROTEINS IN THE CRITICAL PATIENT: DOSES CALCULATED BY TOTAL WEIGHT OR BY BODY COMPOSITION PARAMETERS?

I. Isern Alsina^1,*, M. D. M. Fernández Fernández¹, M. Rabaneda Vergara¹, A. Simó Servat², M. Ibarra², F. J. González de Molina¹, E. Piacentini¹, J. M. García Barrionuevo³, J. Trenado Álvarez¹

¹ICU, ²Endocrinology, ³Radiology, Hospital Universitari Mútua de Terrassa, Terrassa, Spain

 

Rationale: Sarcopenia is defined as muscle failure with a decrease in muscle strength and mass. Few interventions have proven effective in preventing its onset. Nutrition can play a fundamental role.

Body composition in the critical patient is altered both by the inflammatory process and by the fact that they are a population at risk, with more history predisposing to sarcopenia.

Guidelines recommend 1.3g of protein/kg of body weight (BW), however, they do not consider the alteration in body composition, which could explain why women benefit less from high protein doses.

The aim was to compare the protein intake calculated by BW vs. fat free mass (FFM) adjusted for overhydration.

Methods: Prospective, observational study in a mixed ICU, approved by the hospital's ethics committee. Patients > 18 years, within the first 48 hours and with a predicted need for mechanical ventilation > 48 hours.

Results: 39 patients, with mean age 59.5 (±12.5), 22% women. APACHE II of 16 (±8). Duration of mechanical ventilation: 15 days (±14) and 12 (30%) patients required tracheostomy. 37.5% mortality.

The mean BW was 82 kg (±17) and the FFM was 44 kg (±14). The BMI was 28 (±6.45). The amount of protein calculated by BW was 104g (±28) and calculated by FFM was 82g (±25) (p<0.001).

BW for women was 79.3 kg (±18.5) and 82.72 (±17) in men. FFM was 36 Kg (±9.5) a 47% (±15) of BW in female and 48 Kg (±11) a 59% (±12) in male (p<0.05).

The calculated protein for women was 103g (±24) by BW and 67g (±17) by FFM (p<0.05). For men: 104g (±29) and 87g (±26) (p<0.05) respectively. There are no differences between the values calculated by BW between men and women (p>0.05) (, but there are when calculated by FFM (p<0.05).

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Conclusion: Significant discrepancies are evident when calculating protein intake using BW vs. FFM, especially in women. The data suggest that protein dosing should be individualized according to body composition.

Disclosure of Interest: None declared