The Clinical Impacts of Using Modular Protein Formulas in Critically Ill Patients Who are Taking Standard Enteral Nutritional Formulas

Most critically ill patients are under stress conditions from a variety of insults, which are primarily characterised by protein hypercatabolism to fuel the organs of the body and sustain life. The aim of this study was to evaluate the clinical impacts of using available modular protein formulas (e.g. PROSource®TF or Whey Protein 100% Powder) to increase protein provision in critically ill patients who were using standard formulas. Methods: We performed a retrospective analysis of 75 patients admitted to the adult Intensive Care Unit between April 2017 and January 2019 for whom nutritional and non-nutritional data were known. All continuous variables for patients were expressed as the Mean±SD by using the independent samples T-test, while categorical and ordinal variables were expressed as numbers with percentages by using the Chi square test or as a median (interquartile range) using the Mann-Whitney U test, respectively. Analysis values were compared for the two tested groups (survivors vs. non-survivors) and the non-survival group was further analysed after being divided into 2 subgroups, early and late mortality. Results: The mean overall age was 56.92±9.55 years and 50 subjects (66.66%) were male. The early, late, and overall 28-day ICU mortality rates were 6.67%, 16%, and 22.67%, respectively. Baseline pre-ICU admission days, ICU stay days, and overall hospital stay days were significantly higher in non-survivors than in survivors (8.88±3.52 days, 15.82±3.86 days, and 24.71±0.77 days vs. 2.81±1.42 days, 9.81±1.42 days, and 12.62±2.84 days, respectively). Ventilation-free days were significantly higher in survivors than nonsurvivors (5.75±1.03 days vs. 2.04±1.44 days). Albumin was significantly higher in survivors than in non-survivors (3.93±0.49 g/dl vs. 2.73±0.89 g/dl) with a mean difference of +1.08±0.43 g/dl. Conclusion: Modular protein formulas like PROSource®TF or reconstituted whey protein powder are effective at increasing or at least stabilising serum albumin levels in critically ill patients and combating the hypercatabolic state in order to decrease ventilator free days, overall hospital length of stay, early and late mortality, and overall 28 day-ICU mortality.