prospective, comparative, observational study will be conducted at the Critical Care Department, Fayoum University Hospital, to evaluate the impact of a high-protein diet versus a standard-protein diet in mechanically ventilated patients with severe pneumonia.

prospective, comparative, observational study will be conducted at the Critical Care Department, Fayoum University Hospital, aims to evaluate the effect of a high-protein diet on clinical outcomes in mechanically ventilated patients with severe pneumonia, focusing on muscle preservation and weaning ability. The specific objectives are:

1. To assess the impact of high-protein intake on skeletal muscle mass using quadriceps ultrasound.
2. To evaluate diaphragmatic function and thickness in relation to protein intake using ultrasound.
3. To determine the effect of high-protein nutrition on weaning success, duration of mechanical ventilation, length of hospital stay and mortality.

Inclusion Criteria:

• Age ≥ 18 years.
• Mechanically ventilated patients with severe pneumonia.
• Expected ICU stay ≥ 72 hours.

Exclusion Criteria:

• Patients who died before 72 hours of ICU admission.

• Chronic liver failure or decompensated cirrhosis.

• End-stage renal disease (CKD stage 5 or dialysis dependent).

• Neuromuscular diseases or pre-existing severe muscle wasting.

• Pregnancy.

• Patients with pre-existing malnutrition (e.g., BMI <18.5 kg/m² ).

• Contraindications to enteral feeding, such as:

  1. Mechanical bowel obstruction.
  2. Severe gastrointestinal bleeding.
  3. High-output fistulas involving the gastrointestinal tract.
  4. Recent gastrointestinal surgery preventing enteral access.

mechanically ventilated patients with severe pneumonia