Discussing protein requirements of intensive care UNIT (ICU) patients

Macro- and micronutrient requirements of intensive care units (ICU) critically ill patients have been actively discussed in recent years. Published in 2016 and 2017 clinical recommendations and reviews suggested significantly increase of protein provision in some populations of ICU patients to 2-2.5 grams/kg/day. However, a detailed analysis of the main sources of these recommendations (the “International Protein Summit” and Guidelines of the American Society for Critical Medicine and the American Society of Parenteral and Enteral Nutrition in 2016) revealed a number of serious contradictions and the absence of an obvious evidence base positions allowing to recommend high doses of protein. Thus, in most references by the supporters of high doses of protein in the ICU, we could not find any serious arguments to recommend the administration of the protein to the patient at a dosage more than 1.5 grams/kg /day. On the contrary, the corridor of optimal protein load, determined in the majority of studies devoted to the patient''s protein and energy needs in ICU - is 1.2-1.5 grams/kg/day. Recommendations for the provision for ICU patients with morbid obesity hypocaloric and high protein diet, first, have a low level of evidence, and secondly, in real clinical practice simply is not feasible.