Fluids, Electrolytes, Acid-Base Disorders, and Nutrition Support

Organization

Recommendation

SCCM/ASPEN (JPEN J Parenter

Enteral Nutr. 2016;40:159-211)

1.2-2 g/kg/d; higher amounts are likely needed for multiple trauma or burns;

higher amounts are needed during continuous renal replacement therapy

(CRRT), up to 2.5 g/kg/d

For patients with open abdomen, provide an additional 15-30 g of protein

per liter of output from wound drain(s) or negative-pressure wound devices

(caused by exposure of peritoneum, which produces high-protein exudate)

International Protein Summit

consensus recommendations

1):142S-151S)—in reference to

ICU patients

BMI < 30 kg/m2: 1.2-2 g/kg/d ABW 1.2 g/kg/d

Obesity (BMI 30-39.9 kg/m2): 2 g/kg IBW/d

Obesity (BMI ≥ 40 kg/m2): 2.5 g/kg IBW/d

AKI: 1.2-2 g/kg/d

Age > 60 y: 2-2.5 g/kg/d

Persistent inflammation catabolism syndrome: 1.2-2 g/kg/d

Infants and children: A minimum of 1.5 g/kg/d

ASPEN 2022

No recommendations for protein beyond 2016 recommendations—see row 1

ESPEN ICU (Clin Nutr.

2023;42:1671-1689)

1.3 g/kg/d

aActual body weight should be used for calculations, except where otherwise specified.

ABW = adjusted body weight; AKI = acute kidney injury; ASPEN = American Society for Parenteral and Enteral Nutrition; ESPEN = European Society for Clinical

Weijs et al. (2012) (JPEN J Parenter Enteral Nutr 2012;36:60-8): 28-day mortality improved in

those who received an average of 1.3 g/kg/day versus 1.1 or 0.8 g/kg/day (886 mixed ICU patients).

Allingstrup et al. (2012) (Clin Nutr 2012;31:462-8): 28-day mortality improved in those who

received an average of 1.5 g/kg/day versus 1.1 or 0.8 g/kg/day (113 mixed ICU patients).

JPEN J Parenter Enteral Nutr 2016;40:45-51: Improved survival with protein intake greater than

80% of goal (1.2 g/kg/day) in 2828 mixed ICU patients. Achieving 80% of caloric goals did not

affect mortality.

(NUTRIC score greater than 4) mixed ICU patients with a prolonged ICU stay of more than 11

days. Low-risk patients were unaffected.

ASPEN guidelines for nutrition support in adult critically ill patients (2022) (JPEN J Parenter

Enteral Nutr 2022;46:12-41): Based on the low number of high-quality trials available for evaluation,

no difference in clinical outcomes has been observed with provision of higher versus lower protein

intake.

hospital discharge between patients who received an average protein intake of 1.6 versus 0.9 g/kg/

day (high protein versus usual dose protein, respectively). Subgroup analyses on alive at discharge

and 60-day mortality favored usual dose protein group for patients with AKI (1301 mixed ICU

patients, 83.6% study population in medical ICU).