A reappraisal of nitrogen requirements for patients with critical illness and trauma

Roland Dickerson, Stefanie L. Pitts, George O. Maish, Thomas J. Schroeppel, Louis J. Magnotti, Martin Croce, Gayle Minard, Rex Brown

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Background: Studies regarding protein requirements for patients with critical illness are inconclusive owing to small sample size and population heterogeneity. The primary objectives of this study were to determine the amount of protein required to achieve nitrogen equilibrium or a positive nitrogen balance (NB, j4 g/d or better) and ascertain whether patients with traumatic brain injury (TBI) exhibit greater protein catabolism than those without TBI. Methods: Adult patients admitted to the trauma center, given specialized nutrition support, and had an NB determination within 5 days to 14 days after injury were evaluated. Patients with obesity, incomplete urine collection, kidney disease, corticosteroid or pentobarbital therapy, or an oral diet were excluded. Results: A total of 300 NB determinations from 249 patients were evaluated. Increasing the protein dosage generally resulted in improved NB; however, the data were highly variable. Of the patients who received a protein in take of 2g/kg per day or greater, 54% achieved nitrogen equilibrium or positive NB (j4 g/d or better) in contrast to 38% and 29% of patients who received 1.5 g/kg per day to 1.99 g/kg per day and 1 g/kg per day to 1.49 g/kg per day, respectively (p < 0.001). There was no significant difference in NB between patients with and without TBI at similar protein intakes. Conclusion: A higher protein intake was generally associated with an improved NB; yet, many patients remained having a negative NB. A protein dosage of 2 g/kg per day or greater was more successful in achieving nitrogen equilibrium than were lower-dosage intakes. Patients with TBI do not exhibit significantly greater protein catabolism than do patients without TBI.

Original languageEnglish (US)
Pages (from-to)549-557
Number of pages9
JournalJournal of Trauma and Acute Care Surgery
Volume73
Issue number3
DOIs
StatePublished - Sep 1 2012

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Critical Illness
Nitrogen
Wounds and Injuries
Proteins
Urine Specimen Collection
Trauma Centers
Kidney Diseases
Pentobarbital
Population Characteristics
Sample Size
Adrenal Cortex Hormones
Obesity
Traumatic Brain Injury
Diet

All Science Journal Classification (ASJC) codes

  • Critical Care and Intensive Care Medicine
  • Surgery

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A reappraisal of nitrogen requirements for patients with critical illness and trauma. / Dickerson, Roland; Pitts, Stefanie L.; Maish, George O.; Schroeppel, Thomas J.; Magnotti, Louis J.; Croce, Martin; Minard, Gayle; Brown, Rex.

In: Journal of Trauma and Acute Care Surgery, Vol. 73, No. 3, 01.09.2012, p. 549-557.

Research output: Contribution to journalArticle

Dickerson, Roland ; Pitts, Stefanie L. ; Maish, George O. ; Schroeppel, Thomas J. ; Magnotti, Louis J. ; Croce, Martin ; Minard, Gayle ; Brown, Rex. / A reappraisal of nitrogen requirements for patients with critical illness and trauma. In: Journal of Trauma and Acute Care Surgery. 2012 ; Vol. 73, No. 3. pp. 549-557.
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