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Background: Critically ill patients with muscle wasting experience prolonged intensive care unit (ICU) stays, delayed weaning, and higher mortality. Trauma-induced stress disrupts protein metabolism, leading to immunosuppression and muscle loss. This study evaluates whether high-protein intake through enteral nutrition preserves muscle mass and improves clinical outcomes compared to standard protein intake.Methods: In our multicenter research, 102 critically ill, mechanically ventilated patients (age, 39±7; female, 52; body mass index, 23.8±2.7 kg/m2) were assigned randomly to receive either a high-protein (2.2 g/kg BW/day) or standard (1.5 g/kg BW/day) diet. Enteral nutrition was individualized based on energy expenditure. Ultrasound measured whether the rectus femoris muscle cross-sectional area (RFM-9 CSA) and pennation angle correlated with dietary intake. The data are presented as mean±standard deviation.Results: Protein intake was 1.8±0.2 vs. 1.2±0.4 g/kg/day in high-protein and standard groups, respectively. In the intervention and standard groups, the baseline RFM-CSA and Pennation angle were 11.43±0.87 mm vs. 11.3±0.91 mm and 9.1±0.58 mm vs. 8.91±1.04 mm (P>0.05). Days 5, 10, and 20 showed significant variations in RFM-CSA and pennation angle (P<0.001). The intervention group experienced a shorter ICU length of stay (47±19.5 vs. 56.3±26.9 days, P=0.001) and a shorter period of mechanical ventilation (33±2.3 vs. 30±3.5 days, P=0.001).Conclusions: Early high protein intake significantly preserves muscle mass, reducing the duration of stay in the ICU and the need for mechanical ventilation.

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Effect of standard- versus high-protein enteral feeding on rectus femoris muscle mass in mechanically ventilated traumatic brain injury patients : a prospective randomized study in Egypt and the United States Hanan Elkalawy, Pavan Sekhar, Mona Fayad, Mohamed Barrima, Mohammad Abdullah p. 160-173
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