Investigation of protein intake status and analysis of influencing factors in general surgery intensive care unit patients: A mixed-method study_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LI Jiaqi ,  YAO Honglin , YE Xianghong

Department of General Surgery, Eastern Theater General Hospital of Chinese People’s Liberation Army, Nanjing 210001, P. R. China;

Corresponding?author：

YAO Honglin, Email: 1357236687@qq.com

Keywords：

enteral nutrition; protein supplement; general surgery intensive care unit; influence factor; mix-method study

DOI：

10.7507/1007-9424.202408149

Video：

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Objective To investigate the protein intake of patients in the general surgery intensive care unit (ICU) and to analyze the factors, both hindering and facilitating, that affecting protein intake from the perspective of healthcare professionals. Methods A mixed-methods approach was used in this study, including a quantitative study and a qualitative study. The quantitative study was use to assess the protein intake in the ICU patients. The qualitative study was used to analyze the perspectives of healthcare professionals via semi-structured interviews. In the quantitative study, 32 variables were analyzed, and the sample size was estimated to be 10 times the number of study variables. The qualitative study employed the maximum difference sampling strategy, with the sample size determined by data saturation. The multiple linear regression was used to identify the risk factors affecting protein intake achievement, with a significance level of α=0.05. Results The quantitative study included 459 patients, with a protein intake of (0.739±0.552) g/(kg·d). Of the patients, 90 (19.6%) had a protein intake of 1.2–2.0 g/(kg·d), 11 (2.3%) had 2.0 g/(kg·d) or more, and 358 (78.0%) had less 1.2 g/(kg·d). The multiple linear regression analysis identified several risk factors influencing protein intake attainment, including male, higher body mass index, elevated blood glucose levels upon ICU admission, early initiation of enteral nutrition (≤48 h), nasoenteric tube placement, and the only use of enteral nutrition feedings. In the qualitative study, three key themes relevant protein intake attainment were identified from the interviews: inadequate infrastructure, healthcare workers’ factors, and patient-related factors. Conclusions The findings of this study suggest a substantial gap between the protein intake of general surgical ICU patients and the guideline-recommended intake. The study highlights patient groups at risk for inadequate protein intake based on identified risk factors. Future efforts should focus on improving the efficiency of protein supplementation, enhancing the nutritional status of patients, standardizing protein supplementation protocols, and increasing education for both healthcare workers and patients.

Citation： LI Jiaqi, YAO Honglin, YE Xianghong. Investigation of protein intake status and analysis of influencing factors in general surgery intensive care unit patients: A mixed-method study. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(3): 347-353. doi: 10.7507/1007-9424.202408149 Copy

1.	Elke G, van Zanten AR, Lemieux M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care, 2016, 20(1): 117. doi: 10.1186/s13054-016-1298-1.
2.	Preiser JC, Arabi YM, Berger MM, et al. A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice. Crit Care, 2021, 25(1): 424. doi: 10.1186/s13054-021-03847-4.
3.	Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr, 2022, 46(1): 12-41.
4.	Heyland DK, Weijs PJ, Coss-Bu JA, et al. Protein delivery in the intensive care unit: Optimal or suboptimal?. Nutr Clin Pract, 2017, 32(1_suppl): 58S-71S. doi: 10.1177/0884533617691244.
5.	徐穎, 梁培, 虞文魁, 等. 早期足量蛋白質攝入對重癥患者結局的影響. 中華臨床營養雜志, 2019, 27(3): 133-137.
6.	Heyland DK, Patel J, Compher C, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet, 2023, 401(10376): 568-576.
7.	林佳佳, 李維勤, 于凱江. 推動危重癥患者腸內營養的規范化實施. 中華重癥醫學電子雜志(網絡版), 2020, 6(4): 357-360.
8.	倪平, 陳京立, 劉娜. 護理研究中量性研究的樣本量估計. 中華護理雜志, 2010, 45(4): 378-380.
9.	王沈華, 張茂. 危重癥患者靜脈使用胰島素控制高血糖指南. 中華急診醫學雜志, 2013, 22(8): 838-839.
10.	Iwashyna TJ, Deane AM. Individualizing endpoints in randomized clinical trials to better inform individual patient care: the TARGET proposal. Crit Care, 2016, 20(1): 218. doi: 10.1186/s13054-016-1388-0.
11.	Summers MJ, Chapple LA, McClave SA, et al. Event-rate and delta inflation when evaluating mortality as a primary outcome from randomized controlled trials of nutritional interventions during critical illness: a systematic review. Am J Clin Nutr, 2016, 103(4): 1083-1090.
12.	Ferrie S, Allman-Farinelli M, Daley M, et al. Protein requirements in the critically ill: A randomized controlled trial using parenteral nutrition. JPEN J Parenter Enteral Nutr, 2016, 40(6): 795-805.
13.	Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr, 2023, 42(9): 1671-1689.
14.	Karamanlis A, Chaikomin R, Doran S, et al. Effects of protein on glycemic and incretin responses and gastric emptying after oral glucose in healthy subjects. Am J Clin Nutr, 2007, 86(5): 1364-1368.
15.	程相超, 袁啟東, 趙建紅. 重癥急性胰腺炎患者實施腸內營養支持治療對免疫及營養狀態指標的影響. 中國普外基礎與臨床雜志, 2019, 26(9): 1067-1071.
16.	Li J, Wang L, Zhang H, et al. Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis. J Intensive Care, 2023, 11(1): 29. doi: 10.1186/s40560-023-00674-3.
17.	Aarsland D, Batzu L, Halliday GM, et al. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers, 2021, 7(1): 47. doi: 10.1038/s41572-021-00280-3.
18.	Martin CM, Doig GS, Heyland DK, et al. Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ, 2004, 170(2): 197-204.
19.	Doig GS, Simpson F, Finfer S, et al. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. JAMA, 2008, 300(23): 2731-2741.
20.	Barrocas A, Schwartz DB, Bistrian BR, et al. Nutrition support teams: Institution, evolution, and innovation. Nutr Clin Pract, 2023, 38(1): 10-26.
21.	李陽洋, 邵小平, 蔣卓娟, 等. 早期腸內營養集束化喂養方案對重癥患者營養熱卡達標率及喂養不耐受的效果研究. 軍事護理, 2022, 39(9): 41-44, 52.
22.	Heyland DK, Murch L, Cahill N, et al. Enhanced protein-energy provision via the enteral route feeding protocol in critically ill patients: results of a cluster randomized trial. Crit Care Med, 2013, 41(12): 2743-2753.
23.	葉佩玲, 袁星竹, 劉常清, 等. 胃癌患者術后腸內營養不耐受預防及處理措施的研究進展. 中國普外基礎與臨床雜志, 2024, 31(12): 1522-1527.

1. Elke G, van Zanten AR, Lemieux M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care, 2016, 20(1): 117. doi: 10.1186/s13054-016-1298-1.
2. Preiser JC, Arabi YM, Berger MM, et al. A guide to enteral nutrition in intensive care units: 10 expert tips for the daily practice. Crit Care, 2021, 25(1): 424. doi: 10.1186/s13054-021-03847-4.
3. Compher C, Bingham AL, McCall M, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr, 2022, 46(1): 12-41.
4. Heyland DK, Weijs PJ, Coss-Bu JA, et al. Protein delivery in the intensive care unit: Optimal or suboptimal?. Nutr Clin Pract, 2017, 32(1_suppl): 58S-71S. doi: 10.1177/0884533617691244.
5. 徐穎, 梁培, 虞文魁, 等. 早期足量蛋白質攝入對重癥患者結局的影響. 中華臨床營養雜志, 2019, 27(3): 133-137.
6. Heyland DK, Patel J, Compher C, et al. The effect of higher protein dosing in critically ill patients with high nutritional risk (EFFORT Protein): an international, multicentre, pragmatic, registry-based randomised trial. Lancet, 2023, 401(10376): 568-576.
7. 林佳佳, 李維勤, 于凱江. 推動危重癥患者腸內營養的規范化實施. 中華重癥醫學電子雜志(網絡版), 2020, 6(4): 357-360.
8. 倪平, 陳京立, 劉娜. 護理研究中量性研究的樣本量估計. 中華護理雜志, 2010, 45(4): 378-380.
9. 王沈華, 張茂. 危重癥患者靜脈使用胰島素控制高血糖指南. 中華急診醫學雜志, 2013, 22(8): 838-839.
10. Iwashyna TJ, Deane AM. Individualizing endpoints in randomized clinical trials to better inform individual patient care: the TARGET proposal. Crit Care, 2016, 20(1): 218. doi: 10.1186/s13054-016-1388-0.
11. Summers MJ, Chapple LA, McClave SA, et al. Event-rate and delta inflation when evaluating mortality as a primary outcome from randomized controlled trials of nutritional interventions during critical illness: a systematic review. Am J Clin Nutr, 2016, 103(4): 1083-1090.
12. Ferrie S, Allman-Farinelli M, Daley M, et al. Protein requirements in the critically ill: A randomized controlled trial using parenteral nutrition. JPEN J Parenter Enteral Nutr, 2016, 40(6): 795-805.
13. Singer P, Blaser AR, Berger MM, et al. ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit. Clin Nutr, 2023, 42(9): 1671-1689.
14. Karamanlis A, Chaikomin R, Doran S, et al. Effects of protein on glycemic and incretin responses and gastric emptying after oral glucose in healthy subjects. Am J Clin Nutr, 2007, 86(5): 1364-1368.
15. 程相超, 袁啟東, 趙建紅. 重癥急性胰腺炎患者實施腸內營養支持治療對免疫及營養狀態指標的影響. 中國普外基礎與臨床雜志, 2019, 26(9): 1067-1071.
16. Li J, Wang L, Zhang H, et al. Different definitions of feeding intolerance and their associations with outcomes of critically ill adults receiving enteral nutrition: a systematic review and meta-analysis. J Intensive Care, 2023, 11(1): 29. doi: 10.1186/s40560-023-00674-3.
17. Aarsland D, Batzu L, Halliday GM, et al. Parkinson disease-associated cognitive impairment. Nat Rev Dis Primers, 2021, 7(1): 47. doi: 10.1038/s41572-021-00280-3.
18. Martin CM, Doig GS, Heyland DK, et al. Multicentre, cluster-randomized clinical trial of algorithms for critical-care enteral and parenteral therapy (ACCEPT). CMAJ, 2004, 170(2): 197-204.
19. Doig GS, Simpson F, Finfer S, et al. Effect of evidence-based feeding guidelines on mortality of critically ill adults: a cluster randomized controlled trial. JAMA, 2008, 300(23): 2731-2741.
20. Barrocas A, Schwartz DB, Bistrian BR, et al. Nutrition support teams: Institution, evolution, and innovation. Nutr Clin Pract, 2023, 38(1): 10-26.
21. 李陽洋, 邵小平, 蔣卓娟, 等. 早期腸內營養集束化喂養方案對重癥患者營養熱卡達標率及喂養不耐受的效果研究. 軍事護理, 2022, 39(9): 41-44, 52.
22. Heyland DK, Murch L, Cahill N, et al. Enhanced protein-energy provision via the enteral route feeding protocol in critically ill patients: results of a cluster randomized trial. Crit Care Med, 2013, 41(12): 2743-2753.
23. 葉佩玲, 袁星竹, 劉常清, 等. 胃癌患者術后腸內營養不耐受預防及處理措施的研究進展. 中國普外基礎與臨床雜志, 2024, 31(12): 1522-1527.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Investigation of protein intake status and analysis of influencing factors in general surgery intensive care unit patients: A mixed-method study

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