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Review
. 2022 Aug 1;28(4):367-373.
doi: 10.1097/MCC.0000000000000959. Epub 2022 Jul 5.

Protein metabolism in critical illness

Lee-Anne S Chapple  1   2   3 , Rob J J van Gassel  4   5 , Olav Rooyackers  6   7
Affiliations
Review

Protein metabolism in critical illness

Lee-Anne S Chapple et al. Curr Opin Crit Care. .

Abstract

Purpose of review: Critically ill patients experience skeletal muscle wasting that may contribute to the profound functional deficits in those that survive the initial injury. Augmented protein delivery has the potential to attenuate muscle loss, yet the ability for dietary protein to improve patient outcomes is reliant on effective protein metabolism. This review will discuss the recent literature on protein delivery and digestion, amino acid absorption, and muscle protein synthesis (MPS) in critically ill adults.

Recent findings: Critically ill patients are prescribed protein doses similar to international recommendations, yet actual delivery remains inadequate. The majority of trials that have achieved higher protein doses have observed no effect on muscle mass, strength or function. Critically ill patients have been observed to have minimal deficits in protein digestion and amino acid absorption when delivery bypasses the stomach, yet postprandial MPS is impaired. However, the literature is limited due to the complexities in the direct measurement of protein handling.

Summary: Postprandial MPS is impaired in critically ill patients and may exacerbate muscle wasting experienced by these patients. Studies in critically ill patients require assessment not only of protein delivery, but also utilization prior to implementation of augmented protein doses.

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References

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    1. van Gassel RJJ, Bels J, Remij L, et al. Functional outcomes and their association with physical performance in mechanically ventilated coronavirus disease 2019 survivors at 3 months following hospital discharge: a cohort study. Crit Care Med 2021; 49:1726–1738.
    1. Puthucheary ZA, Rawal J, McPhail M, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013; 310:1591–1600.
    1. Chapple LS, Ridley EJ, Chapman MJ. Trial design in critical care nutrition: the past, present and future. Nutrients 2020; 12:3694.
    1. Liebau F, Deane AM, Rooyackers O. Protein absorption and kinetics in critical illness. Curr Opin Clin Nutr Metab Care 2021; 24:71–78.