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Improvement in Protein Delivery for Critically Ill Patients Requiring High‐Dose Propofol Therapy and Enteral Nutrition
Author(s) -
Buckley Christopher T.,
Van Matre Edward T.,
Fischer Peter E.,
Minard Gayle,
Dickerson Roland N.
Publication year - 2021
Publication title -
nutrition in clinical practice
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.725
H-Index - 71
eISSN - 1941-2452
pISSN - 0884-5336
DOI - 10.1002/ncp.10546
Subject(s) - medicine , enteral administration , propofol , regimen , parenteral nutrition , caloric intake , high protein , anesthesia , gastroenterology , body weight , food science , chemistry
Background Patients with traumatic brain (TBI) injury often require a high dosage of propofol, which can provide an excessive caloric intake. We evaluated our strategy of using liquid protein supplement boluses concurrently with high protein–containing enteral nutrition (EN) formulas and formula rate reduction to avoid caloric overfeeding and inadequate protein intake. Methods Adult patients (aged >17 years) with TBI admitted to the trauma intensive care unit (TICU) who received concurrent propofol and EN were retrospectively reviewed. Caloric intakes from propofol and EN were obtained. Actual protein intake was compared with projected protein intakes from high protein content and standard protein content enteral formulas when given at an isocaloric intake. Results Fifty‐one patients were enrolled. Average caloric intake from propofol was 356 ± 243 kcal/d or 5 ± 3 kcal/kg/d (range, <1–15 kcal/kg/d). Daily EN caloric intake ranged from 7 ± 4 kcal/kg/d (day 2) to 16 ± 9 kcal/kg/d (day 5; P < .001). Average protein intake ranged from 0.6 ± 0.4 g/kg/d (day 2) to 1.5 ± 0.7 g/kg/d (day 5; P < .001). The modified EN strategy resulted in daily delivery of 24%–38% more protein than an isocaloric regimen with a high protein–content formula and twice as much protein than the standard protein–content formula ( P < .001). Conclusion The strategy of providing an EN regimen comprised liquid protein boluses, and high and very high protein–containing EN formulas at a reduced rate improved protein delivery without caloric overfeeding.