Protein requirements, morbidity and mortality in critically ill patients: fundamentals and applications
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 ubiqu...
| Main Authors: | , , |
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| Format: | Online |
| Language: | English |
| Published: |
Associação Brasileira de Medicina intensiva
2013
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| Online Access: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031858/ |
| Summary: | 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. |
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