Amino Acid Nutrition in the Critically-ill

Enhancing the Anabolic Effect of Nutrition in Critically Ill Patients by Administering Exogenous Amino Acids

Enhancing the anabolic effect of nutrition in critically ill patients by administering exogenous amino acids.

Critically-ill patients admitted to the intensive care unit are invariably catabolic and are commonly undernourished. Previous observational studies indicate that increased dietary administration of protein or essential amino acids might be associated with improved clinical outcomes. The investigators propose that the parenteral supplementation of intravenous amino acids in critically-ill patients will restore anabolic processes and that anabolism is associated with molecular markers of amino acid sensing and protein synthesis. The results from this study will establish biomarkers of anabolism (i.e., nutritional success) that can be used in future clinical trials on the use of amino acid supplementation in the critically-ill.

Inclusion Criteria:

• Mechanically ventilated adult patients (>18 years old) admitted to ICU with an expected ICU dependency (alive and need for mechanical ventilation
• Vasopressor therapy, or mechanical circulatory support) at the point of screening of an additional 3 days, as estimated by the treating physician.

Exclusion Criteria:

• Patients who are moribund (expected death within 48 hours)
• Expected to have life-sustaining treatments withdrawn in the next 3 days
• Those with a contraindication to enteral nutrition (EN)
• Already on parenteral nutrition (PN)
• Those with acute fulminant hepatitis or severe chronic liver disease (Child's class C)
• Patients on extracorporeal membrane oxygenation or carbon dioxide removal* Patients with organ transplantation
• Those with a broncho-pleural fistula
• Patients with documented allergies to any of the study nutrients or its excipients will be excluded.
• Patients requiring continuous renal replacement therapy or extracorporeal membrane oxygenation are excluded due to inability to accurately measure protein turnover.