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Original Article
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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
- Acute Crit Care. 2026;41(1):160-173. Published online November 24, 2025
- DOI: https://doi.org/10.4266/acc.001025
- 2,766 View
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- 1 Web of Science
- 3 Crossref
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Abstract
PDF - 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, 51; body mass index, 30.3±1.8 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 (47.0±19.5 vs. 56.3±26.9 days, P=0.001) and a shorter period of mechanical ventilation (33±3.5 vs. 33±2.3 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. -
Citations
Citations to this article as recorded by
- Efficacy and safety of higher versus lower protein provision with meaningful dose separation in critically ill adults: a systematic review and meta-analysis of randomized controlled trials
Yun Zhou, Xiuxiu Hao, Run Pan, Tiantian Li, Zhiliang Yang, Zheng Wang, Yi Xiao
Frontiers in Nutrition.2026;[Epub] CrossRef - Nutrition management in critically ill surgical patients: a clinical practice guideline appraisal and synthesis
Chen Xin, Yuhong Luo, Yuhua Liu, Yan Xu, Guixin Liu, Binru Han, Frances Lin
Clinical Nutrition.2026; 65: 106755. CrossRef - Effects of higher versus lower protein intake in critically ill patients: a systematic review and meta-analysis
Shige Li, Yusheng Hou, Xinyu Li, Hongyu Jin, Leilei Fu, Shengchen Wang, Xiangrui Li, Meng Sun, Haijia Hou, Dandan Song, Bing Dai, Hongwen Zhao, Wei Wang, Jian Kang, Wei Tan
Frontiers in Nutrition.2026;[Epub] CrossRef
- Efficacy and safety of higher versus lower protein provision with meaningful dose separation in critically ill adults: a systematic review and meta-analysis of randomized controlled trials
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