Christopher Buckley, BCCCP, MS, PharmD
Assistant Professor of Pharmacy Practice
n/a
Jackson, Tennessee
Disclosure information not submitted.
Nivedita Prasanna, MD
Department of Anesthesiology and Critical Care Medicine
George Washington University
Washington, District of Columbia, United States
Disclosure information not submitted.
Abby Mays, n/a
Department of Nutrition
Jackson Madison County General Hospital, United States
Disclosure information not submitted.
Jeanette Tinsley, n/a
Department of Nutrition
Jackson Madison County General Hospital, United States
Disclosure information not submitted.
Roland Dickerson, PharmD, BCNSP,FCCM
Department of Clinical Pharmacy and Translational Science
University of Tennessee College of Pharmacy, United States
Disclosure information not submitted.
Title: Protein Requirements in Critically Ill Patients with COVID-19
Introduction: Recent studies in critically ill patients with coronavirus disease 2019 (COVID-19) using indirect calorimetry indicate the presence of hypermetabolism, however protein requirements in this patient population is unknown.
Methods: Adult patients ( > 17 years old) with a diagnosis of COVID-19 requiring mechanical ventilation, received continuous enteral nutrition and had a twenty-four hour urine collection for nitrogen balance determination were evaluated retrospectively. The primary objective of this study was to assess protein requirements in critically ill patients with COVID-19. Data are expressed as mean + standard deviation with a P value < 0.05 as significant.
Results: Twenty-nine nitrogen balance determinations were provided from twenty-two critically ill patients with COVID-19. Caloric and protein intakes were 12 + 8 kcal/kg/d and 0.9 + 0.7 g/kg/g on the day of nitrogen balance. Nitrogen balance was -12.2 + 10.9 g/d. Five patients achieved nitrogen equilibrium (nitrogen balance of -4 g/d or better). Those who achieved nitrogen equilibrium received more protein than those who did not achieve nitrogen equilibrium (1.2 + 0.4 g/kg/d vs 0.8 + 0.8 g/kg/d, P = 0.046). Linear regression for nitrogen balance in response in increases in protein intake was: Nitrogen Balance = 8.5*protein intake (g/kg/d) - 18.8 (r = 0.45, P < 0.001).
Conclusions: Critically ill patients with COVID-19 often display a negative nitrogen balance. Individualization of protein intake for critically ill patients with COVID-19 is warranted due to the high variability of the nitrogen accretion response to increases in protein intake.