PW01 - ENERGY AND PROTEIN ADEQUACY IMPROVES FOLLOWING AN INDIVIDUALLY TAILORED, STEP-WISE NUTRITION PROTOCOL IN POST-ICU PATIENTS: THE PROSPECT-II STUDY

PW01

ENERGY AND PROTEIN ADEQUACY IMPROVES FOLLOWING AN INDIVIDUALLY TAILORED, STEP-WISE NUTRITION PROTOCOL IN POST-ICU PATIENTS: THE PROSPECT-II STUDY

M. C. Paulus^1,2, I. W. K. Kouw^1,2, N. van Beek-Westeneng^1,2, I. de Leeuw¹, E. C. van Lingen^1,2, M. Holverda³, B. Strookappe⁴, A. R. H. van Zanten^1,2,*

¹Intensive Care Medicine & Research, Gelderse Vallei Hospital, Ede, ²Division of Human Nutrition and Health, Wageningen University & Research , Wageningen, ³Department of Dietetics, ⁴Department of Physical Therapy, Gelderse Vallei Hospital, Ede, Netherlands

Rationale: Adequate nutritional intake is essential for recovery in ICU survivors, yet nutritional intake substantially declines post-ICU especially during the transition to oral feeding. The present study evaluates the effect of a tailored, step-wise nutrition protocol on energy and protein intake adequacy from ICU to hospital discharge.

Methods: In this prospective, single-centre cohort study (Gelderse Vallei Hospital, Netherlands), 70 adult post-ICU patients (ICU stay ≥72 hrs, receiving enteral feeding) followed a step-wise protocol reducing tube feeding based on prior-day oral intake, aiming for ≥90% of prescribed energy and protein goals. Intake was measured daily until hospital discharge. Primary outcomes were intake adequacy; secondary outcomes included physical performance (MRC, CPAx, handgrip strength), hospital stay, discharge destination, and mortality.

Results: Seventy patients were included (median age 69 [61–74] years; 51% male). Mean energy and protein intake adequacy during the first 14 post-ICU days was 100.2%±28.8 and 97.1%±29.0, respectively. Median hospital stay post-ICU was 10 days [7–16], during which 71% patients transitioned to complete oral intake. Physical performance improved significantly from ICU to hospital discharge: MRC sum score (42 [36–47] to 48 [44–51]), CPAx (25 [18–30] to 40 [34–44]), and handgrip strength (14 [9–21] to 20 [14–28] kg) (all p < 0.001). 

Conclusion: A personalised, step-wise nutrition protocol enabled high energy and protein adequacy (>100% and >95%, respectively) in the first 14 days post-ICU discharge. This approach effectively supported gradual weaning from enteral feeding and increasing oral food intake, while maintaining ≥90% of nutritional targets. The impact on clinical and functional outcomes warrants further investigation.

Disclosure of Interest: M. Paulus: None declared, I. Kouw Grant / Research Support from: NWO ZonMW Veni Fellowship, N. van Beek-Westeneng: None declared, I. de Leeuw: None declared, E. van Lingen: None declared, M. Holverda: None declared, B. Strookappe: None declared, A. van Zanten Grant / Research Support from: Nutricia Danone Research , Other: Prof. Dr. Van Zanten reported receiving honoraria for advisory board meetings, lectures, research, and travel expenses from AOP Pharma, Abbott, Baxter, Cardinal Health, Danone-Nutricia, DIM3, Dutch Medical Food, Fresenius Kabi, GE Healthcare, InBody, Mermaid, Rousselot, and Lyric.