Enteral protein delivery does not improve outcome in critically ill patients: JAMA

A new study published in the Journal of American Medical Association showed that supplementing enteral protein during critical illness did not increase the number of days spent outside of the index hospital and surviving at day 90.

Guidelines indicate supplementing enteral protein during critical illness, however the effect on patient outcomes is unknown. As a result, Matthew Summers and colleagues assessed whether supplementing enteral protein increases days alive and free of hospitalization.

From May 23, 2022, to August 23, 2023, 8 ICUs in Australia and New Zealand provided critically ill patients receiving enteral nutrition for this study. The last follow-up was conducted on November 21, 2023. A comparison was made between two isocaloric enteral formulae: normal protein (63 g protein/L) and boosted protein (100 g protein/L). Over the course of 12 months, ICUs employed formulas in succession for 3 months; 4 ICUs started with increased protein, and 4 ICUs started with regular protein.

The number of days that the patient was alive at day 90 and not admitted to the index hospital was the main outcome. The length of invasive ventilation, intensive care unit, and hospitalization; the incidence of tracheostomy insertion and new renal replacement treatment; the destination of hospital release; and the number of days that survivors were free of the index hospital on day 90 were all examples of secondary outcomes.

There were 3,397 patients in all, with a median age of 61 [IQR 48–71] years with 64% of them being male. There was no significant difference between the high-protein group and the standard-protein group at day 90, with the median number of days alive and out of the hospital being 62 (IQR 0–77) and 64 (IQR 0–77), respectively (median difference −1.97 days; 95% CI, −7.24 to 3.30; P =.46).

At day 90, the normal group's survival rate was 74.0%, whereas the high-protein group's was 72.6% (risk ratio 0.99; 95% CI, 0.95–1.03). Hospital-free days (0.01; 95% CI, −1.94 to 1.96), ventilation time (6.8 hours; 95% CI, −3.0 to 16.5), discharge risks (hospital HR 0.96; ICU HR 0.93), tracheostomy, and new renal treatment (RR 0.97) were the secondary outcomes that exhibited the least amount of variation. Each group's discharge locations were comparable.

Overall, when compared to standard treatment, increasing enteral protein supply in critically sick patients did not result in more days spent alive at day 90 and free of the index hospital. Enteral protein supplementation during severe illness is not supported by these results.

Source:

Summers, M. J., Chapple, L.-A. S., Karahalios, A., Bellomo, R., Chapman, M. J., Ferrie, S., Finnis, M. E., French, C., Hurford, S., Kakho, N., Maiden, M. J., O’Connor, S. N., Peake, S. L., Presneill, J. J., Ridley, E. J., Tran-Duy, A., Williams, P. J., Young, P. J., Zaloumis, S., … TARGET Protein Investigators and for the Australian and New Zealand Intensive Care Society Clinical Trials Group. (2025). Augmented enteral protein during critical illness: The TARGET protein randomized clinical trial. JAMA: The Journal of the American Medical Association. https://doi.org/10.1001/jama.2025.9110