TY  - JOUR
A1  - Dresen, Ellen
A1  - Pimiento, Jose M.
A1  - Patel, Jayshil J.
A1  - Heyland, Daren K.
A1  - Rice, Todd W.
A1  - Stoppe, Christian
T1  - Overview of oxidative stress and the role of micronutrients in critical illness
JF  - Journal of Parenteral and Enteral Nutrition
N2  - Inflammation and oxidative stress represent physiological response mechanisms to different types of stimuli and injury during critical illness. Its proper regulation is fundamental to cellular and organismal survival and are paramount to outcomes and recovery from critical illness. A proper maintenance of the delicate balance between inflammation, oxidative stress, and immune response is crucial for resolution from critical illness with important implications for patient outcome. The extent of inflammation and oxidative stress under normal conditions is limited by the antioxidant defense system of the human body, whereas the antioxidant capacity is commonly significantly compromised, and serum levels of micronutrients and vitamins significantly depleted in patients who are critically ill. Hence, the provision of antioxidants and anti-inflammatory nutrients may help to reduce the extent of oxidative stress and therefore improve clinical outcomes in patients who are critically ill. As existing evidence of the beneficial effects of antioxidant supplementation in patients who are critically ill is still unclear, actual findings about the most promising anti-inflammatory and antioxidative candidates selenium, vitamin C, zinc, and vitamin D will be discussed in this narrative review. The existing evidence provided so far demonstrates that several factors need to be considered to determine the efficacy of an antioxidant supplementation strategy in patients who are critically ill and indicates the need for adequately designed multicenter prospective randomized control trials to evaluate the clinical significance of different types and doses of micronutrients and vitamins in selected groups of patients with different types of critical illness.
KW  - critical illness
KW  - vitamins
KW  - vitamin C
KW  - inflammation
KW  - medical nutrition therapy
KW  - oxidative stress
KW  - selenium
KW  - trace elements
KW  - micronutrients
KW  - vitamin D
KW  - zinc
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-318186
VL  - 47
SP  - S38
EP  - S49
ER  - 
TY  - JOUR
A1  - Stoppe, Christian
A1  - Patel, Jayshil J.
A1  - Zarbock, Alex
A1  - Lee, Zheng-Yii
A1  - Rice, Todd W.
A1  - Mafrici, Bruno
A1  - Wehner, Rebecca
A1  - Chan, Man Hung Manuel
A1  - Lai, Peter Chi Keung
A1  - MacEachern, Kristen
A1  - Myrianthefs, Pavlos
A1  - Tsigou, Evdoxia
A1  - Ortiz-Reyes, Luis
A1  - Jiang, Xuran
A1  - Day, Andrew G.
A1  - Hasan, M. Shahnaz
A1  - Meybohm, Patrick
A1  - Ke, Lu
A1  - Heyland, Daren K.
T1  - The impact of higher protein dosing on outcomes in critically ill patients with acute kidney injury: a post hoc analysis of the EFFORT protein trial
JF  - Critical Care
N2  - Background
Based on low-quality evidence, current nutrition guidelines recommend the delivery of high-dose protein in critically ill patients. The EFFORT Protein trial showed that higher protein dose is not associated with improved outcomes, whereas the effects in critically ill patients who developed acute kidney injury (AKI) need further evaluation. The overall aim is to evaluate the effects of high-dose protein in critically ill patients who developed different stages of AKI.

Methods
In this post hoc analysis of the EFFORT Protein trial, we investigated the effect of high versus usual protein dose (≥ 2.2 vs. ≤ 1.2 g/kg body weight/day) on time-to-discharge alive from the hospital (TTDA) and 60-day mortality and in different subgroups in critically ill patients with AKI as defined by the Kidney Disease Improving Global Outcomes (KDIGO) criteria within 7 days of ICU admission. The associations of protein dose with incidence and duration of kidney replacement therapy (KRT) were also investigated.

Results
Of the 1329 randomized patients, 312 developed AKI and were included in this analysis (163 in the high and 149 in the usual protein dose group). High protein was associated with a slower time-to-discharge alive from the hospital (TTDA) (hazard ratio 0.5, 95% CI 0.4–0.8) and higher 60-day mortality (relative risk 1.4 (95% CI 1.1–1.8). Effect modification was not statistically significant for any subgroup, and no subgroups suggested a beneficial effect of higher protein, although the harmful effect of higher protein target appeared to disappear in patients who received kidney replacement therapy (KRT). Protein dose was not significantly associated with the incidence of AKI and KRT or duration of KRT.

Conclusions
In critically ill patients with AKI, high protein may be associated with worse outcomes in all AKI stages. Recommendation of higher protein dosing in AKI patients should be carefully re-evaluated to avoid potential harmful effects especially in patients who were not treated with KRT.

Trial registration: This study is registered at ClinicalTrials.gov (NCT03160547) on May 17th 2017.
KW  - acute kidney injury
KW  - critical illness
KW  - nutrition support
KW  - protein
KW  - randomized trial
KW  - registry trial
Y1  - 2023
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-357221
VL  - 27
ER  -