Protein nutrition in the ICU: a Delphi exercise to highlight knowledge and opinions of different professional groups involved in patient critical care.

backgroundThe current literature is lacking in relation to the impact of protein nutrition, with and without adjuvant exercise, on patient centred outcomes including muscle recovery following critical illness. The literature has shown that skeletal muscle health is significantly affected in critical illness with potential negative consequences on physical function and quality of life. This Delphi study aims to establish a consensus opinion for the benefits of protein supplementation alone or as part of multicomponent intervention along with physical exercise in critically ill patients through its iterative process to refine expert opinions with regards of this subject. METHODOLOGY: We conducted this Delphi survey among different groups of experts with extensive experience in critical care management specifically in the area of nutrition and physical rehabilitation and prespecified a threshold of 80% of agreement or disagreement to accept or reject statements respectively; allowing for consensus to be achieved. Anonymous feedback was employed to refine statements across consequent rounds. Statistical stability was also tested to verify the consistency of responses.

resultsThe study included 60 statements out of which 18 statements reached agreement (>/= 80%) and only 12 were identified at the near-consensus level (>/= 70%) across the three rounds. It was agreed that physical function, post critical illness quality of life and muscle centred outcomes comprising muscle mass and strength could be enhanced in response to protein provision and adjuvant exercise interventions. However, consensus could not be reached on the most appropriate protein dosage, timing of administration nor on its impact on conventional clinical outcomes.

conclusionThis study is the first to seek a consensus on the potential benefits of optimal protein provision with and without concomitant exercise on various clinical and patient-centred aspects in the critically ill population. Consensus was attained for a limited number of statements, suggesting that further large robust clinical trials are still required.